401k Plan data: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN plan

AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN
Plan identification number	002

AT HOME HEATH, INC., 401(K) PROFIT SHARING 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.
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.

401k Sponsoring company profile

AT HOME HEATH, INC. has sponsored the creation of one or more 401k plans.

Company Name: AT HOME HEATH, INC.

Employer identification number (EIN): 232879776

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2019-01-01 C. SHELBY DURHAM 2020-09-22 C. SHELBY DURHAM 2020-09-22
002 2018-01-01 C. SHELBY DURHAM 2019-08-29 C. SHELBY DURHAM 2019-08-29
002 2017-01-01
002 2016-01-01
002 2015-01-01
002 2014-01-01
002 2013-01-01 C. SHELBY DURHAM
002 2012-01-01 C. SHELBY DURHAM
002 2011-01-01 C. SHELBY DURHAM 2012-10-09
002 2010-01-01 C. SHELBY DURHAM 2011-10-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2019-01-01	C. SHELBY DURHAM	2020-09-22	C. SHELBY DURHAM	2020-09-22
002	2018-01-01	C. SHELBY DURHAM	2019-08-29	C. SHELBY DURHAM	2019-08-29
002	2017-01-01
002	2016-01-01
002	2015-01-01
002	2014-01-01
002	2013-01-01	C. SHELBY DURHAM
002	2012-01-01	C. SHELBY DURHAM
002	2011-01-01	C. SHELBY DURHAM	2012-10-09
002	2010-01-01	C. SHELBY DURHAM	2011-10-12

Plan Statistics for AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN

Measure Date Value
2019: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 0
Number of participants with account balances 2019-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 10
Total of all active and inactive participants 2018-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 10
Number of participants with account balances 2018-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 16
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 5
Total of all active and inactive participants 2017-01-01 21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 21
Number of participants with account balances 2017-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 18
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 4
Total of all active and inactive participants 2016-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 22
Number of participants with account balances 2016-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 30
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 18
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 4
Total of all active and inactive participants 2015-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 22
Number of participants with account balances 2015-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 30
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 30
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 30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 30
Number of participants with account balances 2014-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 30
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 0
Total of all active and inactive participants 2013-01-01 30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 30
Number of participants with account balances 2013-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 21
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 8
Total of all active and inactive participants 2012-01-01 29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 29
Number of participants with account balances 2012-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2019: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	0
Number of participants with account balances	2019-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	10
Total of all active and inactive participants	2018-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	10
Number of participants with account balances	2018-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	16
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	5
Total of all active and inactive participants	2017-01-01	21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	21
Number of participants with account balances	2017-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	18
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	4
Total of all active and inactive participants	2016-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	22
Number of participants with account balances	2016-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	30
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	18
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	4
Total of all active and inactive participants	2015-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	22
Number of participants with account balances	2015-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	30
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	30
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	30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	30
Number of participants with account balances	2014-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	30
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	0
Total of all active and inactive participants	2013-01-01	30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	30
Number of participants with account balances	2013-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	21
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	8
Total of all active and inactive participants	2012-01-01	29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	29
Number of participants with account balances	2012-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2019 : AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$21,039
Expenses. Total of all expenses incurred	2019-12-31	$182,276
Benefits paid (including direct rollovers)	2019-12-31	$181,503
Total plan assets at end of year	2019-12-31	$0
Total plan assets at beginning of year	2019-12-31	$161,237
Value of fidelity bond covering the plan	2019-12-31	$250,000
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Other income received	2019-12-31	$21,039
Net income (gross income less expenses)	2019-12-31	$-161,237
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$161,237
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$773
2018 : AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$-11,195
Expenses. Total of all expenses incurred	2018-12-31	$44,893
Benefits paid (including direct rollovers)	2018-12-31	$42,300
Total plan assets at end of year	2018-12-31	$161,237
Total plan assets at beginning of year	2018-12-31	$217,325
Value of fidelity bond covering the plan	2018-12-31	$250,000
Expenses. Other expenses not covered elsewhere	2018-12-31	$2,593
Other income received	2018-12-31	$-11,195
Net income (gross income less expenses)	2018-12-31	$-56,088
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$161,237
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$217,325
Assets. Value of participant loans	2018-12-31	$34,286
2017 : AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$25,839
Expenses. Total of all expenses incurred	2017-12-31	$1,417
Total plan assets at end of year	2017-12-31	$217,325
Total plan assets at beginning of year	2017-12-31	$192,903
Value of fidelity bond covering the plan	2017-12-31	$250,000
Expenses. Other expenses not covered elsewhere	2017-12-31	$1,417
Other income received	2017-12-31	$25,839
Net income (gross income less expenses)	2017-12-31	$24,422
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$217,325
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$192,903
Assets. Value of participant loans	2017-12-31	$33,076
2016 : AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$10,867
Expenses. Total of all expenses incurred	2016-12-31	$15,163
Benefits paid (including direct rollovers)	2016-12-31	$13,771
Total plan assets at end of year	2016-12-31	$192,903
Total plan assets at beginning of year	2016-12-31	$197,199
Value of fidelity bond covering the plan	2016-12-31	$20,000
Expenses. Other expenses not covered elsewhere	2016-12-31	$1,392
Other income received	2016-12-31	$10,867
Net income (gross income less expenses)	2016-12-31	$-4,296
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$192,903
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$197,199
Assets. Value of participant loans	2016-12-31	$31,892
2015 : AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$-1,329
Expenses. Total of all expenses incurred	2015-12-31	$1,401
Total plan assets at end of year	2015-12-31	$197,199
Total plan assets at beginning of year	2015-12-31	$199,929
Value of fidelity bond covering the plan	2015-12-31	$20,000
Expenses. Other expenses not covered elsewhere	2015-12-31	$1,401
Other income received	2015-12-31	$-1,329
Net income (gross income less expenses)	2015-12-31	$-2,730
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$197,199
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$199,929
Assets. Value of participant loans	2015-12-31	$30,753
2014 : AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$7,450
Expenses. Total of all expenses incurred	2014-12-31	$1,389
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$199,929
Total plan assets at beginning of year	2014-12-31	$193,868
Value of fidelity bond covering the plan	2014-12-31	$20,000
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$1,389
Other income received	2014-12-31	$7,450
Net income (gross income less expenses)	2014-12-31	$6,061
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$199,929
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$193,868
Assets. Value of participant loans	2014-12-31	$29,663
Total contributions received or receivable from employer(s)	2014-12-31	$0
2013 : AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$25,882
Expenses. Total of all expenses incurred	2013-12-31	$17,408
Benefits paid (including direct rollovers)	2013-12-31	$16,084
Total plan assets at end of year	2013-12-31	$193,868
Total plan assets at beginning of year	2013-12-31	$185,394
Value of fidelity bond covering the plan	2013-12-31	$20,000
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$1,324
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$25,882
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$8,474
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$193,868
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$185,394
Assets. Value of participant loans	2013-12-31	$28,617
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$20,550
Expenses. Total of all expenses incurred	2012-12-31	$10,419
Benefits paid (including direct rollovers)	2012-12-31	$9,099
Total plan assets at end of year	2012-12-31	$185,394
Total plan assets at beginning of year	2012-12-31	$175,263
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$1,320
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$20,550
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$10,131
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$185,394
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$175,263
Total contributions received or receivable from employer(s)	2012-12-31	$0
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0

Form 5500 Responses for AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN

2019: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	Yes
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: AT HOME HEATH, INC., 401(K) PROFIT SHARING 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	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
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: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 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 – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: AT HOME HEATH, INC., 401(K) PROFIT SHARING PLAN 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 – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

38942

Policy instance

Insurance contract or identification number	38942
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

38942

Policy instance

Insurance contract or identification number	38942
Number of Individuals Covered	11
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $429
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $429
Insurance broker organization code?	4
Insurance broker name	KESTRA INVESTMENT SERVICES LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

38942

Policy instance

Insurance contract or identification number	38942
Number of Individuals Covered	12
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $426
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $426
Insurance broker organization code?	4
Insurance broker name	NFP ADVISOR SERVICES LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

38942

Policy instance

Insurance contract or identification number	38942
Number of Individuals Covered	12
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $420
Commission paid to Insurance Broker	USD $420
Insurance broker organization code?	4
Insurance broker name	NEW ENGLAND SECURITIES CORPORATION

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

38942

Policy instance

Insurance contract or identification number	38942
Number of Individuals Covered	12
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $388
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	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $388
Insurance broker organization code?	5
Insurance broker name	NEW ENGLAND SECURITIES CORPORATION

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

38942

Policy instance

Insurance contract or identification number	38942
Number of Individuals Covered	13
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $411
Total amount of fees paid to insurance company	USD $7
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	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $411
Insurance broker organization code?	5
Amount paid for insurance broker fees	7
Additional information about fees paid to insurance broker	FEE
Insurance broker name	ROSENFELD/TORTU RETIREMENT PLANNING

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Company Name:	AT HOME HEATH, INC.
Employer identification number (EIN):	232879776
NAIC Classification:	621610
NAIC Description:	Home Health Care Services