401k Plan data: EXEMPLA RETIREMENT INCOME SAVINGS PLAN plan

EXEMPLA RETIREMENT INCOME SAVINGS PLAN 401k Plan overview

Plan Name	EXEMPLA RETIREMENT INCOME SAVINGS PLAN
Plan identification number	002

EXEMPLA RETIREMENT INCOME SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Participant-directed brokerage accounts provided as an investment option under the plan.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

SCL HEALTH - FRONT RANGE, INC. has sponsored the creation of one or more 401k plans.

Company Name: SCL HEALTH - FRONT RANGE, INC.

Employer identification number (EIN): 841103606

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about SCL HEALTH - FRONT RANGE, INC.

Jurisdiction of Incorporation: Colorado Department of State

Incorporation Date: 1988-02-24

Company Identification Number: 19881007604

Legal Registered Office Address: 500 Eldorado Blvd Ste 4300
Attn Legal Services
Broomfield
United States of America (USA)
80021

More information about SCL HEALTH - FRONT RANGE, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EXEMPLA RETIREMENT INCOME SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2011-01-01 TODD CONKLIN
002 2010-01-01 TODD A. CONKLIN, SR.
002 2009-01-01 TODD A. CONKLIN, SR.

Plan id#	Filing Submission Date	Name of Administrator
002	2011-01-01	TODD CONKLIN
002	2010-01-01	TODD A. CONKLIN, SR.
002	2009-01-01	TODD A. CONKLIN, SR.

Plan Statistics for EXEMPLA RETIREMENT INCOME SAVINGS PLAN

401k plan membership statisitcs for EXEMPLA RETIREMENT INCOME SAVINGS PLAN

Measure Date Value
2011: EXEMPLA RETIREMENT INCOME SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 10,234
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 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 0
Number of participants with account balances 2011-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: EXEMPLA RETIREMENT INCOME SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 11,744
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 7,991
Number of retired or separated participants receiving benefits 2010-01-01 46
Number of other retired or separated participants entitled to future benefits 2010-01-01 2,188
Total of all active and inactive participants 2010-01-01 10,225
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 9
Total participants 2010-01-01 10,234
Number of participants with account balances 2010-01-01 7,894
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: EXEMPLA RETIREMENT INCOME SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 10,551
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 10,269
Number of retired or separated participants receiving benefits 2009-01-01 41
Number of other retired or separated participants entitled to future benefits 2009-01-01 1,425
Total of all active and inactive participants 2009-01-01 11,735
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 9
Total participants 2009-01-01 11,744
Number of participants with account balances 2009-01-01 7,247
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: EXEMPLA RETIREMENT INCOME SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	10,234
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	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	0
Number of participants with account balances	2011-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: EXEMPLA RETIREMENT INCOME SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	11,744
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	7,991
Number of retired or separated participants receiving benefits	2010-01-01	46
Number of other retired or separated participants entitled to future benefits	2010-01-01	2,188
Total of all active and inactive participants	2010-01-01	10,225
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	9
Total participants	2010-01-01	10,234
Number of participants with account balances	2010-01-01	7,894
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: EXEMPLA RETIREMENT INCOME SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	10,551
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	10,269
Number of retired or separated participants receiving benefits	2009-01-01	41
Number of other retired or separated participants entitled to future benefits	2009-01-01	1,425
Total of all active and inactive participants	2009-01-01	11,735
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	9
Total participants	2009-01-01	11,744
Number of participants with account balances	2009-01-01	7,247
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on EXEMPLA RETIREMENT INCOME SAVINGS PLAN

Measure	Date	Value
2011 : EXEMPLA RETIREMENT INCOME SAVINGS PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets from this plan	2011-12-31	$218,835,091
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	$26,747,395
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$20,866,359
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$20,817,709
Expenses. Certain deemed distributions of participant loans	2011-12-31	$7,635
Value of total corrective distributions	2011-12-31	$3,306
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$26,163,974
Value of total assets at end of year	2011-12-31	$0
Value of total assets at beginning of year	2011-12-31	$212,954,055
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$37,709
Total interest from all sources	2011-12-31	$248,948
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$3,158,378
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2011-12-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$3,158,378
Administrative expenses professional fees incurred	2011-12-31	$564
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	Yes
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
Contributions received from participants	2011-12-31	$24,123,673
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$4,526,659
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$5,469,553
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$2,040,301
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$-264,781
Administrative expenses (other) incurred	2011-12-31	$37,145
Total non interest bearing cash at end of year	2011-12-31	$0
Total non interest bearing cash at beginning of year	2011-12-31	$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	2011-12-31	No
Value of net income/loss	2011-12-31	$5,881,036
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$212,954,055
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$166,617,439
Value of interest in pooled separate accounts at end of year	2011-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$28,607,684
Interest on participant loans	2011-12-31	$248,948
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$520,273
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$520,273
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$7,212,447
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-2,978,232
Net investment gain/loss from pooled separate accounts	2011-12-31	$419,108
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
Contributions received in cash from employer	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$20,817,709
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	Yes
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	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	ERNST & YOUNG LLP
Accountancy firm EIN	2011-12-31	346565596
2010 : EXEMPLA RETIREMENT INCOME SAVINGS PLAN 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$46,097,126
Total of all expenses incurred	2010-12-31	$13,389,200
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$13,236,433
Expenses. Certain deemed distributions of participant loans	2010-12-31	$109,934
Value of total corrective distributions	2010-12-31	$5,914
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$24,921,145
Value of total assets at end of year	2010-12-31	$212,954,055
Value of total assets at beginning of year	2010-12-31	$180,246,129
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$36,919
Total interest from all sources	2010-12-31	$490,726
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$3,202,365
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$3,202,365
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
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
Contributions received from participants	2010-12-31	$22,777,581
Participant contributions at end of year	2010-12-31	$4,526,659
Participant contributions at beginning of year	2010-12-31	$3,616,158
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$5,469,553
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$5,109,523
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$2,143,564
Other income not declared elsewhere	2010-12-31	$507,603
Administrative expenses (other) incurred	2010-12-31	$36,919
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	$32,707,926
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$212,954,055
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$180,246,129
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$166,617,439
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$137,834,178
Value of interest in pooled separate accounts at end of year	2010-12-31	$28,607,684
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$25,757,875
Interest on participant loans	2010-12-31	$257,361
Interest earned on other investments	2010-12-31	$233,365
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$520,273
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$561,069
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$561,069
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$7,212,447
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$7,367,326
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$15,778,399
Net investment gain/loss from pooled separate accounts	2010-12-31	$1,196,888
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$13,236,433
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
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	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	ERNST & YOUNG LLP
Accountancy firm EIN	2010-12-31	346565596
2009 : EXEMPLA RETIREMENT INCOME SAVINGS PLAN 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 EXEMPLA RETIREMENT INCOME SAVINGS PLAN

2011: EXEMPLA RETIREMENT INCOME SAVINGS PLAN 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	Yes
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 – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: EXEMPLA RETIREMENT INCOME SAVINGS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: EXEMPLA RETIREMENT INCOME SAVINGS PLAN 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	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	SCL HEALTH - FRONT RANGE, INC.
Employer identification number (EIN):	841103606
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Colorado Department of State
Incorporation Date:	1988-02-24
Company Identification Number:	19881007604
Legal Registered Office Address:	500 Eldorado Blvd Ste 4300 Attn Legal Services Broomfield United States of America (USA) 80021