401k Plan data: HOME INSTEAD SENIOR CARE 401(K) PLAN plan

HOME INSTEAD SENIOR CARE 401(K) PLAN 401k Plan overview

Plan Name	HOME INSTEAD SENIOR CARE 401(K) PLAN
Plan identification number	001

HOME INSTEAD SENIOR CARE 401(K) 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

HOME INSTEAD SENIOR CARE has sponsored the creation of one or more 401k plans.

Company Name: HOME INSTEAD SENIOR CARE

Employer identification number (EIN): 364514423

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOME INSTEAD SENIOR CARE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 BERT COPPLE 2016-10-17
001 2015-01-01 BERT COPPLE
001 2014-01-01 BERT COPPLE
001 2013-01-01 BERT COPPLE 2014-10-15
001 2012-01-01 TOM ROWLEY 2013-10-14
001 2011-01-01 TOM ROWLEY
001 2010-01-01 TOM ROWLEY
001 2009-01-01 TOM ROWLEY

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2016-01-01	BERT COPPLE	2016-10-17
001	2015-01-01	BERT COPPLE
001	2014-01-01	BERT COPPLE
001	2013-01-01	BERT COPPLE	2014-10-15
001	2012-01-01	TOM ROWLEY	2013-10-14
001	2011-01-01	TOM ROWLEY
001	2010-01-01	TOM ROWLEY
001	2009-01-01	TOM ROWLEY

Plan Statistics for HOME INSTEAD SENIOR CARE 401(K) PLAN

401k plan membership statisitcs for HOME INSTEAD SENIOR CARE 401(K) PLAN

Measure Date Value
2015: HOME INSTEAD SENIOR CARE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 59
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 20
Total of all active and inactive participants 2015-01-01 79
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 79
Number of participants with account balances 2015-01-01 79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: HOME INSTEAD SENIOR CARE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 103
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 16
Total of all active and inactive participants 2014-01-01 119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 119
Number of participants with account balances 2014-01-01 67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2011: HOME INSTEAD SENIOR CARE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 41
Number of other retired or separated participants entitled to future benefits 2011-01-01 3
Total of all active and inactive participants 2011-01-01 44
Total participants 2011-01-01 44
Number of participants with account balances 2011-01-01 11
2010: HOME INSTEAD SENIOR CARE 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 37
Number of other retired or separated participants entitled to future benefits 2010-01-01 4
Total of all active and inactive participants 2010-01-01 41
Total participants 2010-01-01 41
Number of participants with account balances 2010-01-01 12
2009: HOME INSTEAD SENIOR CARE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 47
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 39
Number of retired or separated participants receiving benefits 2009-01-01 3
Total of all active and inactive participants 2009-01-01 42
Total participants 2009-01-01 42
Number of participants with account balances 2009-01-01 15

Measure	Date	Value
2015: HOME INSTEAD SENIOR CARE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	59
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	20
Total of all active and inactive participants	2015-01-01	79
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	79
Number of participants with account balances	2015-01-01	79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: HOME INSTEAD SENIOR CARE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	103
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	16
Total of all active and inactive participants	2014-01-01	119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	119
Number of participants with account balances	2014-01-01	67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2011: HOME INSTEAD SENIOR CARE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	41
Number of other retired or separated participants entitled to future benefits	2011-01-01	3
Total of all active and inactive participants	2011-01-01	44
Total participants	2011-01-01	44
Number of participants with account balances	2011-01-01	11
2010: HOME INSTEAD SENIOR CARE 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	37
Number of other retired or separated participants entitled to future benefits	2010-01-01	4
Total of all active and inactive participants	2010-01-01	41
Total participants	2010-01-01	41
Number of participants with account balances	2010-01-01	12
2009: HOME INSTEAD SENIOR CARE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	47
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	39
Number of retired or separated participants receiving benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	42
Total participants	2009-01-01	42
Number of participants with account balances	2009-01-01	15

Financial Data on HOME INSTEAD SENIOR CARE 401(K) PLAN

Measure	Date	Value
2015 : HOME INSTEAD SENIOR CARE 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$26,768
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$4,405
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$789
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$30,437
Value of total assets at end of year	2015-12-31	$173,827
Value of total assets at beginning of year	2015-12-31	$151,464
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$3,616
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$50,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$29,298
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$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	2015-12-31	No
Value of net income/loss	2015-12-31	$22,363
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$173,827
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$151,464
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in pooled separate accounts at end of year	2015-12-31	$173,827
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$134,757
Net investment gain/loss from pooled separate accounts	2015-12-31	$-3,669
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$1,139
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$16,707
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$789
Contract administrator fees	2015-12-31	$3,616
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	CARNAGHI & SCHWARK, PLLC
Accountancy firm EIN	2015-12-31	461506714
2014 : HOME INSTEAD SENIOR CARE 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$51,100
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$2,524
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$366
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$47,074
Value of total assets at end of year	2014-12-31	$151,464
Value of total assets at beginning of year	2014-12-31	$102,888
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$2,158
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$50,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$30,367
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$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	2014-12-31	No
Value of net income/loss	2014-12-31	$48,576
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$151,464
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$102,888
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$134,757
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$102,888
Interest on participant loans	2014-12-31	$0
Net investment gain/loss from pooled separate accounts	2014-12-31	$4,026
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$16,707
Employer contributions (assets) at end of year	2014-12-31	$16,707
Employer contributions (assets) at beginning of year	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$366
Contract administrator fees	2014-12-31	$2,158
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	CARNAGHI & SCHWARK, PLLC
Accountancy firm EIN	2014-12-31	461506714
2011 : HOME INSTEAD SENIOR CARE 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$2,498
Expenses. Total of all expenses incurred	2011-12-31	$3,291
Benefits paid (including direct rollovers)	2011-12-31	$2,203
Total plan assets at end of year	2011-12-31	$77,600
Total plan assets at beginning of year	2011-12-31	$78,393
Value of fidelity bond covering the plan	2011-12-31	$20,000
Total contributions received or receivable from participants	2011-12-31	$7,138
Other income received	2011-12-31	$-4,640
Net income (gross income less expenses)	2011-12-31	$-793
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$77,600
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$78,393
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$1,088
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$2,203
2010 : HOME INSTEAD SENIOR CARE 401(K) PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$15,510
Expenses. Total of all expenses incurred	2010-12-31	$8,979
Benefits paid (including direct rollovers)	2010-12-31	$7,951
Total plan assets at end of year	2010-12-31	$78,393
Total plan assets at beginning of year	2010-12-31	$71,862
Total contributions received or receivable from participants	2010-12-31	$9,492
Other income received	2010-12-31	$6,018
Net income (gross income less expenses)	2010-12-31	$6,531
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$78,393
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$71,862
Assets. Value of participant loans	2010-12-31	$2,000
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$1,028
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$7,951
2009 : HOME INSTEAD SENIOR CARE 401(K) 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	$12,228

Form 5500 Responses for HOME INSTEAD SENIOR CARE 401(K) PLAN

2015: HOME INSTEAD SENIOR CARE 401(K) 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 benefit arrangement – Insurance	Yes
2014: HOME INSTEAD SENIOR CARE 401(K) 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 benefit arrangement – Insurance	Yes
2011: HOME INSTEAD SENIOR CARE 401(K) 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	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 – 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: HOME INSTEAD SENIOR CARE 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
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: HOME INSTEAD SENIOR CARE 401(K) 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

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP 37332

Policy instance

Insurance contract or identification number	GP 37332
Number of Individuals Covered	79
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $370
Total amount of fees paid to insurance company	USD $266
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 $370
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SALES AND BASE COMMISSIONS
Insurance broker organization code?	4
Insurance broker name	THE RETIREMENT ADVANTAGE INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP 37332

Policy instance

Insurance contract or identification number	GP 37332
Number of Individuals Covered	72
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $288
Total amount of fees paid to insurance company	USD $213
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 $288
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SALES AND BASE COMMISSIONS
Insurance broker organization code?	4
Insurance broker name	THE RETIREMENT ADVANTAGE INC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP37332

Policy instance

Insurance contract or identification number	GP37332
Number of Individuals Covered	14
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $195
Total amount of fees paid to insurance company	USD $142
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

GP37332

Policy instance

Insurance contract or identification number	GP37332
Number of Individuals Covered	12
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $172
Total amount of fees paid to insurance company	USD $89
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

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Company Name:	HOME INSTEAD SENIOR CARE
Employer identification number (EIN):	364514423
NAIC Classification:	621610
NAIC Description:	Home Health Care Services