401k Plan data: INLAND EMPIRE HOME HEALTH & HOSPICE 401K plan

INLAND EMPIRE HOME HEALTH & HOSPICE 401K 401k Plan overview

Plan Name	INLAND EMPIRE HOME HEALTH & HOSPICE 401K
Plan identification number	001

INLAND EMPIRE HOME HEALTH & HOSPICE 401K Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.

401k Sponsoring company profile

INLAND EMPIRE HOME HEALTH & HOSPICE has sponsored the creation of one or more 401k plans.

Company Name: INLAND EMPIRE HOME HEALTH & HOSPICE

Employer identification number (EIN): 451633699

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INLAND EMPIRE HOME HEALTH & HOSPICE 401K

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01 MICHAEL FOUTZ 2020-12-01
001 2019-01-01 MICHAEL FOUTZ 2020-07-15
001 2018-01-01 MICHAEL FOUTZ 2019-07-31
001 2017-01-01 MICHAEL FOUTZ 2018-07-03
001 2016-01-01 MICHAEL FOUTZ 2017-07-06
001 2015-01-01 MICHAEL FOUTZ
001 2014-01-01 MICHAEL FOUTZ
001 2013-01-01 MICHAEL FOUTZ MICHAEL FOUTZ 2015-08-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2020-01-01	MICHAEL FOUTZ	2020-12-01
001	2019-01-01	MICHAEL FOUTZ	2020-07-15
001	2018-01-01	MICHAEL FOUTZ	2019-07-31
001	2017-01-01	MICHAEL FOUTZ	2018-07-03
001	2016-01-01	MICHAEL FOUTZ	2017-07-06
001	2015-01-01	MICHAEL FOUTZ
001	2014-01-01	MICHAEL FOUTZ
001	2013-01-01	MICHAEL FOUTZ		MICHAEL FOUTZ	2015-08-20

Plan Statistics for INLAND EMPIRE HOME HEALTH & HOSPICE 401K

401k plan membership statisitcs for INLAND EMPIRE HOME HEALTH & HOSPICE 401K

Measure Date Value
2015: INLAND EMPIRE HOME HEALTH & HOSPICE 401K 2015 401k membership
Total participants, beginning-of-year 2015-01-01 92
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 55
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 29
Total of all active and inactive participants 2015-01-01 84
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 84
Number of participants with account balances 2015-01-01 51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: INLAND EMPIRE HOME HEALTH & HOSPICE 401K 2014 401k membership
Total participants, beginning-of-year 2014-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 75
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 17
Total of all active and inactive participants 2014-01-01 92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 92
Number of participants with account balances 2014-01-01 55
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: INLAND EMPIRE HOME HEALTH & HOSPICE 401K 2013 401k membership
Total participants, beginning-of-year 2013-01-01 180
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 129
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 3
Total of all active and inactive participants 2013-01-01 132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 132
Number of participants with account balances 2013-01-01 81
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2015: INLAND EMPIRE HOME HEALTH & HOSPICE 401K 2015 401k membership
Total participants, beginning-of-year	2015-01-01	92
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	55
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	29
Total of all active and inactive participants	2015-01-01	84
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	84
Number of participants with account balances	2015-01-01	51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: INLAND EMPIRE HOME HEALTH & HOSPICE 401K 2014 401k membership
Total participants, beginning-of-year	2014-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	75
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	17
Total of all active and inactive participants	2014-01-01	92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	92
Number of participants with account balances	2014-01-01	55
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: INLAND EMPIRE HOME HEALTH & HOSPICE 401K 2013 401k membership
Total participants, beginning-of-year	2013-01-01	180
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	129
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	3
Total of all active and inactive participants	2013-01-01	132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	132
Number of participants with account balances	2013-01-01	81
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Financial Data on INLAND EMPIRE HOME HEALTH & HOSPICE 401K

Measure	Date	Value
2015 : INLAND EMPIRE HOME HEALTH & HOSPICE 401K 2015 401k financial data
Total income from all sources	2015-12-31	$1,075,413
Expenses. Total of all expenses incurred	2015-12-31	$168,010
Benefits paid (including direct rollovers)	2015-12-31	$163,768
Total plan assets at end of year	2015-12-31	$907,403
Value of fidelity bond covering the plan	2015-12-31	$400,000
Total contributions received or receivable from participants	2015-12-31	$87,769
Contributions received from other sources (not participants or employers)	2015-12-31	$7,810
Other income received	2015-12-31	$979,834
Net income (gross income less expenses)	2015-12-31	$907,403
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$907,403
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$0
Assets. Value of participant loans	2015-12-31	$39,491
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$4,242
2014 : INLAND EMPIRE HOME HEALTH & HOSPICE 401K 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	$276,495
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$665,235
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$654,383
Expenses. Certain deemed distributions of participant loans	2014-12-31	$4,492
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$210,490
Value of total assets at end of year	2014-12-31	$993,647
Value of total assets at beginning of year	2014-12-31	$1,382,387
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$6,360
Total interest from all sources	2014-12-31	$5,014
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$400,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$187,655
Participant contributions at end of year	2014-12-31	$40,182
Participant contributions at beginning of year	2014-12-31	$84,754
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$22,835
Other income not declared elsewhere	2014-12-31	$578
Administrative expenses (other) incurred	2014-12-31	$6,360
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	$-388,740
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$993,647
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,382,387
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 registered invesment companies (eg mutual funds) at end of year	2014-12-31	$827,378
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$1,180,987
Interest on participant loans	2014-12-31	$2,383
Interest earned on other investments	2014-12-31	$2,631
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$126,087
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$116,646
Net investment gain/loss from pooled separate accounts	2014-12-31	$60,413
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$654,383
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	MURLI M TIWARI, CPA, INC.
Accountancy firm EIN	2014-12-31	270332764
2013 : INLAND EMPIRE HOME HEALTH & HOSPICE 401K 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	$449,510
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$114,513
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$108,431
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$266,221
Value of total assets at end of year	2013-12-31	$1,382,387
Value of total assets at beginning of year	2013-12-31	$1,047,390
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$6,082
Total interest from all sources	2013-12-31	$5,323
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$400,000
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	$242,767
Participant contributions at end of year	2013-12-31	$84,754
Participant contributions at beginning of year	2013-12-31	$20,578
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$23,454
Other income not declared elsewhere	2013-12-31	$10
Administrative expenses (other) incurred	2013-12-31	$6,082
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	$334,997
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$1,382,387
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,047,390
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	$1,180,987
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$859,240
Interest on participant loans	2013-12-31	$2,314
Interest earned on other investments	2013-12-31	$3,009
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$116,646
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$167,572
Net investment gain/loss from pooled separate accounts	2013-12-31	$177,956
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$108,431
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	MURLI M TIWARI, CPA, INC.
Accountancy firm EIN	2013-12-31	270332764

Form 5500 Responses for INLAND EMPIRE HOME HEALTH & HOSPICE 401K

2015: INLAND EMPIRE HOME HEALTH & HOSPICE 401K 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: INLAND EMPIRE HOME HEALTH & HOSPICE 401K 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: INLAND EMPIRE HOME HEALTH & HOSPICE 401K 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
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

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFZ386

Policy instance

Insurance contract or identification number	VFZ386
Number of Individuals Covered	84
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,588
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?	Yes
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 $2,565
Insurance broker organization code?	3
Insurance broker name	COOK CLARENCE B

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFZ386

Policy instance

Insurance contract or identification number	VFZ386
Number of Individuals Covered	92
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $640
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 $640
Insurance broker organization code?	3
Insurance broker name	RHEA JULIA L

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

Policy instance

Number of Individuals Covered	85
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,647
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?	Yes
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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

VFZ386

Policy instance

Insurance contract or identification number	VFZ386
Number of Individuals Covered	132
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,647
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?	Yes
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 $2,623
Insurance broker organization code?	3
Insurance broker name	COOK CLARENCE B

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Company Name:	INLAND EMPIRE HOME HEALTH & HOSPICE
Employer identification number (EIN):	451633699
NAIC Classification:	622000
NAIC Description:	Hospitals