401k Plan data: BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN plan

BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN 401k Plan overview

Plan Name	BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN
Plan identification number	501

BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental

401k Sponsoring company profile

BALL HEALTHCARE SERVICES, INC has sponsored the creation of one or more 401k plans.

Company Name: BALL HEALTHCARE SERVICES, INC

Employer identification number (EIN): 630858774

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2012-01-01 MATT HALL, DIRECTOR OF REIMBURSEMEN
501 2011-01-01 MATT HALL DIRECTOR OF REIMBURSEMEN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2012-01-01	MATT HALL, DIRECTOR OF REIMBURSEMEN
501	2011-01-01	MATT HALL DIRECTOR OF REIMBURSEMEN

Plan Statistics for BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN

401k plan membership statisitcs for BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN

Measure Date Value
2012: BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 947
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 947
Total of all active and inactive participants 2012-01-01 947
Total participants 2012-01-01 0
2011: BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 953
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 953
Total of all active and inactive participants 2011-01-01 953
Total participants 2011-01-01 953

Measure	Date	Value
2012: BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	947
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	947
Total of all active and inactive participants	2012-01-01	947
Total participants	2012-01-01	0
2011: BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	953
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	953
Total of all active and inactive participants	2011-01-01	953
Total participants	2011-01-01	953

Financial Data on BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN

Measure	Date	Value
2012 : BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN 2012 401k financial data
Value of total assets at end of year	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in common/collective trusts at end of year	2012-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
2011 : BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN 2011 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Did the plan have assets held for investment	2011-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No

Form 5500 Responses for BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN

2012: BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: BALL HEALTHCARE SERVICES, INC. SELF INSURED INSURANCE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	BALL HEALTHCARE SERVICES, INC
Employer identification number (EIN):	630858774
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities