401k Plan data: NEIGHBORHOOD HEALTH SAVINGS PLAN plan

NEIGHBORHOOD HEALTH SAVINGS PLAN 401k Plan overview

Plan Name	NEIGHBORHOOD HEALTH SAVINGS PLAN
Plan identification number	002

NEIGHBORHOOD HEALTH SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan not intended to be qualified - A plan not intended to be qualified under Code sections 401, 403, or 408.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Life insurance
Long-term disability cover
Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

NEIGHBORHOOD HEALTH AGENCIES, INC. has sponsored the creation of one or more 401k plans.

Company Name: NEIGHBORHOOD HEALTH AGENCIES, INC.

Employer identification number (EIN): 232324782

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NEIGHBORHOOD HEALTH SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2014-01-01 ANDREA L. DEVOTI
002 2013-07-01 ANDREA DEVOTI
002 2013-01-01 ANDREA L DEVOTI
002 2012-07-01 ANDREA L. DEVOTI

Plan id#	Filing Submission Date	Name of Administrator
002	2014-01-01	ANDREA L. DEVOTI
002	2013-07-01	ANDREA DEVOTI
002	2013-01-01	ANDREA L DEVOTI
002	2012-07-01	ANDREA L. DEVOTI

Plan Statistics for NEIGHBORHOOD HEALTH SAVINGS PLAN

401k plan membership statisitcs for NEIGHBORHOOD HEALTH SAVINGS PLAN

Measure Date Value
2014: NEIGHBORHOOD HEALTH SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 265
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
Number of participants with account balances 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: NEIGHBORHOOD HEALTH SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 120
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 162
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 0
Total of all active and inactive participants 2013-07-01 162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-07-01 0
Total participants 2013-07-01 162
Number of participants with account balances 2013-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-07-01 0
Total participants, beginning-of-year 2013-01-01 245
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 220
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 45
Total of all active and inactive participants 2013-01-01 265
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 265
Number of participants with account balances 2013-01-01 209
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 20
2012: NEIGHBORHOOD HEALTH SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 198
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 207
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 38
Total of all active and inactive participants 2012-07-01 245
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 245
Number of participants with account balances 2012-07-01 206
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 5

Measure	Date	Value
2014: NEIGHBORHOOD HEALTH SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	265
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
Number of participants with account balances	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: NEIGHBORHOOD HEALTH SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	120
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	162
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	0
Total of all active and inactive participants	2013-07-01	162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-07-01	0
Total participants	2013-07-01	162
Number of participants with account balances	2013-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-07-01	0
Total participants, beginning-of-year	2013-01-01	245
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	220
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	45
Total of all active and inactive participants	2013-01-01	265
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	265
Number of participants with account balances	2013-01-01	209
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	20
2012: NEIGHBORHOOD HEALTH SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	198
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	207
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	38
Total of all active and inactive participants	2012-07-01	245
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	245
Number of participants with account balances	2012-07-01	206
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	5

Financial Data on NEIGHBORHOOD HEALTH SAVINGS PLAN

Measure	Date	Value
2014 : NEIGHBORHOOD HEALTH SAVINGS PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-07-11	$0
Total transfer of assets from this plan	2014-07-11	$4,434,902
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-07-11	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-07-11	$0
Total income from all sources (including contributions)	2014-07-11	$540,508
Total loss/gain on sale of assets	2014-07-11	$0
Total of all expenses incurred	2014-07-11	$65,306
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-07-11	$54,660
Value of total corrective distributions	2014-07-11	$9,626
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-07-11	$375,208
Value of total assets at end of year	2014-07-11	$0
Value of total assets at beginning of year	2014-07-11	$3,959,700
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-07-11	$1,020
Total interest from all sources	2014-07-11	$257
Total dividends received (eg from common stock, registered investment company shares)	2014-07-11	$30,422
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-07-11	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2014-07-11	$0
Total dividends received from registered investment company shares (eg mutual funds)	2014-07-11	$30,422
Administrative expenses professional fees incurred	2014-07-11	$1,020
Was this plan covered by a fidelity bond	2014-07-11	Yes
Value of fidelity bond cover	2014-07-11	$1,000,000
If this is an individual account plan, was there a blackout period	2014-07-11	Yes
Were there any nonexempt tranactions with any party-in-interest	2014-07-11	No
Contributions received from participants	2014-07-11	$303,803
Participant contributions at end of year	2014-07-11	$0
Participant contributions at beginning of year	2014-07-11	$14,762
Income. Received or receivable in cash from other sources (including rollovers)	2014-07-11	$3,960
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-07-11	No
Value of net income/loss	2014-07-11	$475,202
Value of net assets at end of year (total assets less liabilities)	2014-07-11	$0
Value of net assets at beginning of year (total assets less liabilities)	2014-07-11	$3,959,700
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-07-11	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-07-11	No
Were any leases to which the plan was party in default or uncollectible	2014-07-11	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-07-11	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-07-11	$3,944,938
Interest on participant loans	2014-07-11	$257
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-07-11	$134,621
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-07-11	No
Was there a failure to transmit to the plan any participant contributions	2014-07-11	No
Has the plan failed to provide any benefit when due under the plan	2014-07-11	No
Contributions received in cash from employer	2014-07-11	$67,445
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-07-11	$54,660
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	2014-07-11	Yes
Did the plan have assets held for investment	2014-07-11	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	2014-07-11	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-07-11	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-07-11	Yes
Opinion of an independent qualified public accountant for this plan	2014-07-11	Disclaimer
Accountancy firm name	2014-07-11	SIMIONE MACCA & LARROW, LLP
Accountancy firm EIN	2014-07-11	061586075
2013 : NEIGHBORHOOD HEALTH SAVINGS PLAN 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	$1,195,220
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$235,653
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$234,500
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$733,842
Value of total assets at end of year	2013-12-31	$3,959,700
Value of total assets at beginning of year	2013-12-31	$3,000,133
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$1,153
Total interest from all sources	2013-12-31	$225
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$123,705
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$123,705
Administrative expenses professional fees incurred	2013-12-31	$1,153
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$572,629
Participant contributions at end of year	2013-12-31	$14,762
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$45,149
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	$959,567
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$3,959,700
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$3,000,133
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$3,944,938
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$3,000,133
Interest on participant loans	2013-12-31	$225
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$337,448
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
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
Contributions received in cash from employer	2013-12-31	$116,064
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$234,500
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	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	SIMIONE MACCA & LARROW, LLP
Accountancy firm EIN	2013-12-31	061586075
2012 : NEIGHBORHOOD HEALTH SAVINGS PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$81,878
Total income from all sources (including contributions)	2012-12-31	$571,184
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$112,599
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$112,599
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$483,264
Value of total assets at end of year	2012-12-31	$3,000,133
Value of total assets at beginning of year	2012-12-31	$2,623,426
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$45,627
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$45,627
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$226,051
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$195,086
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$-81,878
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$268
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$76,235
Other income not declared elsewhere	2012-12-31	$1,483
Liabilities. Value of operating payables at beginning of year	2012-12-31	$5,643
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	$458,585
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$3,000,133
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$2,541,548
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 registered invesment companies (eg mutual funds) at end of year	2012-12-31	$3,000,133
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$2,623,158
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$40,810
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
Contributions received in cash from employer	2012-12-31	$62,127
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$194,477
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	2012-12-31	Yes
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	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	SIMIONE MACCA & LARROW, LLP
Accountancy firm EIN	2012-12-31	061586075

Form 5500 Responses for NEIGHBORHOOD HEALTH SAVINGS PLAN

2014: NEIGHBORHOOD HEALTH SAVINGS PLAN 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 - Trust	Yes
2013: NEIGHBORHOOD HEALTH SAVINGS PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	Yes
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
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: NEIGHBORHOOD HEALTH SAVINGS PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

086977

Policy instance

Insurance contract or identification number	086977
Number of Individuals Covered	162
Insurance policy start date	2013-07-01
Insurance policy end date	2014-07-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISABILITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $68,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

086977

Policy instance

Insurance contract or identification number	086977
Number of Individuals Covered	162
Insurance policy start date	2013-07-01
Insurance policy end date	2014-07-01
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISABILITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $68,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	BENESERV INC

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Company Name:	NEIGHBORHOOD HEALTH AGENCIES, INC.
Employer identification number (EIN):	232324782
NAIC Classification:	621610
NAIC Description:	Home Health Care Services