401k Plan data: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO plan

NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 401k Plan overview

Plan Name	NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO
Plan identification number	001

NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
Covered by PBGC - Plan is covered under the PBGC insurance program (see ERISA section 4021).
Plan covered by PBGC that was terminated and closed out for PBGC purposes - Before the end of the plan year (or a prior plan year), (1) the plan terminated in a standard (or distress) termination and completed the distribution of plan assets in satisfaction of all benefit liabilities (or all ERISA Title IV benefits for distress termination); or (2) a trustee was appointed for a terminated plan pursuant to ERISA section 4042.
Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).
Plan sponsor(s) received services of leased employees, as defined in Code section 414(n), during the plan year.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).
U.S.-based plan that covers residents of Puerto Rico and is qualified under both Code section 401 and section 1165 of the Puerto Rico Code.

401k Sponsoring company profile

PUERTO RICO HEALTH PLAN, INC. has sponsored the creation of one or more 401k plans.

Company Name: PUERTO RICO HEALTH PLAN, INC.

Employer identification number (EIN): 660195325

NAIC Classification: 524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 TERRENCE COONEY LANCE ANDERMAN 2015-06-12
001 2013-01-01 TERRENCE COONEY LANCE ANDERMAN 2014-10-15
001 2012-01-01 TERRENCE COONEY LANCE ANDERMAN 2013-10-15
001 2011-01-01 DAVID MANUSZAK LANCE ANDERMAN 2012-10-15
001 2009-01-01 DAVID MANUSZAK LANCE ANDERMAN 2010-10-11

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2014-01-01	TERRENCE COONEY	LANCE ANDERMAN	2015-06-12
001	2013-01-01	TERRENCE COONEY	LANCE ANDERMAN	2014-10-15
001	2012-01-01	TERRENCE COONEY	LANCE ANDERMAN	2013-10-15
001	2011-01-01	DAVID MANUSZAK	LANCE ANDERMAN	2012-10-15
001	2009-01-01	DAVID MANUSZAK	LANCE ANDERMAN	2010-10-11

Plan Statistics for NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO

401k plan membership statisitcs for NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO

Measure Date Value
2014: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2014 401k membership
Total participants, beginning-of-year 2014-01-01 262
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2013 401k membership
Total participants, beginning-of-year 2013-01-01 266
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 65
Number of other retired or separated participants entitled to future benefits 2013-01-01 192
Total of all active and inactive participants 2013-01-01 257
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 5
Total participants 2013-01-01 262
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2012 401k membership
Total participants, beginning-of-year 2012-01-01 429
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
Number of retired or separated participants receiving benefits 2012-01-01 64
Number of other retired or separated participants entitled to future benefits 2012-01-01 198
Total of all active and inactive participants 2012-01-01 262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 4
Total participants 2012-01-01 266
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2011 401k membership
Total participants, beginning-of-year 2011-01-01 453
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
Number of retired or separated participants receiving benefits 2011-01-01 52
Number of other retired or separated participants entitled to future benefits 2011-01-01 373
Total of all active and inactive participants 2011-01-01 425
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 4
Total participants 2011-01-01 429
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2009 401k membership
Total participants, beginning-of-year 2009-01-01 518
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 36
Number of retired or separated participants receiving benefits 2009-01-01 42
Number of other retired or separated participants entitled to future benefits 2009-01-01 382
Total of all active and inactive participants 2009-01-01 460
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 4
Total participants 2009-01-01 464
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 13

Measure	Date	Value
2014: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2014 401k membership
Total participants, beginning-of-year	2014-01-01	262
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2013 401k membership
Total participants, beginning-of-year	2013-01-01	266
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	65
Number of other retired or separated participants entitled to future benefits	2013-01-01	192
Total of all active and inactive participants	2013-01-01	257
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	5
Total participants	2013-01-01	262
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2012 401k membership
Total participants, beginning-of-year	2012-01-01	429
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
Number of retired or separated participants receiving benefits	2012-01-01	64
Number of other retired or separated participants entitled to future benefits	2012-01-01	198
Total of all active and inactive participants	2012-01-01	262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	4
Total participants	2012-01-01	266
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2011 401k membership
Total participants, beginning-of-year	2011-01-01	453
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
Number of retired or separated participants receiving benefits	2011-01-01	52
Number of other retired or separated participants entitled to future benefits	2011-01-01	373
Total of all active and inactive participants	2011-01-01	425
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	4
Total participants	2011-01-01	429
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2009 401k membership
Total participants, beginning-of-year	2009-01-01	518
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	36
Number of retired or separated participants receiving benefits	2009-01-01	42
Number of other retired or separated participants entitled to future benefits	2009-01-01	382
Total of all active and inactive participants	2009-01-01	460
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	4
Total participants	2009-01-01	464
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	13

Financial Data on NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO

Measure	Date	Value
2014 : NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-08-14	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-08-14	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-08-14	$0
Total income from all sources (including contributions)	2014-08-14	$5,000,012
Total loss/gain on sale of assets	2014-08-14	$0
Total of all expenses incurred	2014-08-14	$17,871,893
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-08-14	$17,726,965
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-08-14	$4,189,084
Value of total assets at end of year	2014-08-14	$0
Value of total assets at beginning of year	2014-08-14	$12,871,881
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-08-14	$144,928
Total interest from all sources	2014-08-14	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-08-14	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-08-14	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2014-08-14	$0
Administrative expenses professional fees incurred	2014-08-14	$128,407
Was this plan covered by a fidelity bond	2014-08-14	Yes
Value of fidelity bond cover	2014-08-14	$500,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-08-14	$0
Were there any nonexempt tranactions with any party-in-interest	2014-08-14	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	2014-08-14	No
Value of net income/loss	2014-08-14	$-12,871,881
Value of net assets at end of year (total assets less liabilities)	2014-08-14	$0
Value of net assets at beginning of year (total assets less liabilities)	2014-08-14	$12,871,881
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-08-14	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-08-14	No
Were any leases to which the plan was party in default or uncollectible	2014-08-14	No
Investment advisory and management fees	2014-08-14	$11,035
Assets. Value of investments in 103.12 investment entities at beginning of year	2014-08-14	$12,871,881
Expenses. Payments to insurance carriers foe the provision of benefits	2014-08-14	$13,098,863
Net gain/loss from 103.12 investment entities	2014-08-14	$810,928
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-08-14	Yes
Was there a failure to transmit to the plan any participant contributions	2014-08-14	No
Has the plan failed to provide any benefit when due under the plan	2014-08-14	No
Contributions received in cash from employer	2014-08-14	$4,189,084
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-08-14	$4,628,102
Contract administrator fees	2014-08-14	$5,486
Did the plan have assets held for investment	2014-08-14	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	2014-08-14	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-08-14	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-08-14	No
Opinion of an independent qualified public accountant for this plan	2014-08-14	Unqualified
Accountancy firm name	2014-08-14	BDO USA, LLP
Accountancy firm EIN	2014-08-14	135381590
2013 : NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$1,475,327
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$1,679,745
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,623,619
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$0
Value of total assets at end of year	2013-12-31	$12,871,881
Value of total assets at beginning of year	2013-12-31	$13,076,299
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$56,126
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2013-12-31	$0
Administrative expenses professional fees incurred	2013-12-31	$18,914
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	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	2013-12-31	No
Value of net income/loss	2013-12-31	$-204,418
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$12,871,881
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$13,076,299
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Investment advisory and management fees	2013-12-31	$26,040
Assets. Value of investments in 103.12 investment entities at end of year	2013-12-31	$12,871,881
Assets. Value of investments in 103.12 investment entities at beginning of year	2013-12-31	$13,076,299
Net gain/loss from 103.12 investment entities	2013-12-31	$1,475,327
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,623,619
Contract administrator fees	2013-12-31	$11,172
Did the plan have assets held for investment	2013-12-31	Yes
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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	BDO USA, LLP
Accountancy firm EIN	2013-12-31	135381590
2012 : NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$2,078,104
Total of all expenses incurred	2012-12-31	$5,894,644
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$5,822,437
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$0
Value of total assets at end of year	2012-12-31	$13,076,299
Value of total assets at beginning of year	2012-12-31	$16,892,839
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$72,207
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$29,229
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Administrative expenses (other) incurred	2012-12-31	$0
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
Value of net income/loss	2012-12-31	$-3,816,540
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$13,076,299
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$16,892,839
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
Investment advisory and management fees	2012-12-31	$30,891
Assets. Value of investments in 103.12 investment entities at end of year	2012-12-31	$13,076,299
Assets. Value of investments in 103.12 investment entities at beginning of year	2012-12-31	$14,892,839
Net gain/loss from 103.12 investment entities	2012-12-31	$2,078,104
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	Yes
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
Contributions received in cash from employer	2012-12-31	$0
Employer contributions (assets) at beginning of year	2012-12-31	$2,000,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$5,822,437
Contract administrator fees	2012-12-31	$12,087
Did the plan have assets held for investment	2012-12-31	Yes
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
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	BDO USA, LLP
Accountancy firm EIN	2012-12-31	135381590
2011 : NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$2,294,347
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$1,683,570
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,619,487
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$2,000,000
Value of total assets at end of year	2011-12-31	$16,892,839
Value of total assets at beginning of year	2011-12-31	$16,282,062
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$64,083
Total interest from all sources	2011-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$21,052
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
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
Value of net income/loss	2011-12-31	$610,777
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$16,892,839
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$16,282,062
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
Investment advisory and management fees	2011-12-31	$29,889
Assets. Value of investments in 103.12 investment entities at end of year	2011-12-31	$14,892,839
Assets. Value of investments in 103.12 investment entities at beginning of year	2011-12-31	$15,967,062
Net gain/loss from 103.12 investment entities	2011-12-31	$294,347
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
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
Contributions received in cash from employer	2011-12-31	$2,000,000
Employer contributions (assets) at end of year	2011-12-31	$2,000,000
Employer contributions (assets) at beginning of year	2011-12-31	$315,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,619,487
Contract administrator fees	2011-12-31	$13,142
Did the plan have assets held for investment	2011-12-31	Yes
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
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	BDO USA, LLP
Accountancy firm EIN	2011-12-31	135381590
2010 : NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets from this plan	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$2,347,875
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,291,962
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,220,367
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$315,000
Value of total assets at end of year	2010-12-31	$16,282,062
Value of total assets at beginning of year	2010-12-31	$15,226,149
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$71,595
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$26,459
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Administrative expenses (other) incurred	2010-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$1,055,913
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$16,282,062
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$15,226,149
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Investment advisory and management fees	2010-12-31	$32,223
Assets. Value of investments in 103.12 investment entities at end of year	2010-12-31	$15,967,062
Assets. Value of investments in 103.12 investment entities at beginning of year	2010-12-31	$12,126,149
Net gain/loss from 103.12 investment entities	2010-12-31	$2,032,875
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$315,000
Employer contributions (assets) at end of year	2010-12-31	$315,000
Employer contributions (assets) at beginning of year	2010-12-31	$3,100,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$1,220,367
Contract administrator fees	2010-12-31	$12,913
Did the plan have assets held for investment	2010-12-31	Yes
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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	BDO USA, LLP
Accountancy firm EIN	2010-12-31	135381590
2009 : NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO

2014: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	Yes
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: NON-CONTRIBUTORY RETIREMENT PROGRAM FOR CERTAIN EMPLOYEES OF LA CRUZ AZUL DE PUERTO RICO 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	PUERTO RICO HEALTH PLAN, INC.
Employer identification number (EIN):	660195325
NAIC Classification:	524140