401k Plan data: HOSPICE OF SURRY RETIREMENT PLAN plan

HOSPICE OF SURRY RETIREMENT PLAN 401k Plan overview

Plan Name	HOSPICE OF SURRY RETIREMENT PLAN
Plan identification number	001

HOSPICE OF SURRY RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
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.

401k Sponsoring company profile

HOSPICE OF SURRY, INC. has sponsored the creation of one or more 401k plans.

Company Name: HOSPICE OF SURRY, INC.

Employer identification number (EIN): 561346584

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOSPICE OF SURRY RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-10-01
001 2020-10-01
001 2019-10-01
001 2018-10-01
001 2017-10-01
001 2016-10-01 BARRY DOWELL
001 2015-10-01 BARRY DOWELL
001 2014-10-01 RON PARDUE
001 2013-10-01 RON PARDUE
001 2012-10-01 RON PARDUE
001 2011-10-01 RON PARDUE RON PARDUE 2013-07-15
001 2009-10-01 RON PARDUE
001 2008-10-01

Plan Statistics for HOSPICE OF SURRY RETIREMENT PLAN

401k plan membership statisitcs for HOSPICE OF SURRY RETIREMENT PLAN

Measure Date Value
2021: HOSPICE OF SURRY RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 427
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 339
Number of retired or separated participants receiving benefits 2021-10-01 28
Number of other retired or separated participants entitled to future benefits 2021-10-01 61
Total of all active and inactive participants 2021-10-01 428
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-10-01 0
Total participants 2021-10-01 428
Number of participants with account balances 2021-10-01 371
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-10-01 33
2020: HOSPICE OF SURRY RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 383
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 322
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 93
Total of all active and inactive participants 2020-10-01 415
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-10-01 0
Total participants 2020-10-01 415
Number of participants with account balances 2020-10-01 366
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-10-01 33
2019: HOSPICE OF SURRY RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 453
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 315
Number of retired or separated participants receiving benefits 2019-10-01 0
Number of other retired or separated participants entitled to future benefits 2019-10-01 64
Total of all active and inactive participants 2019-10-01 379
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-10-01 0
Total participants 2019-10-01 379
Number of participants with account balances 2019-10-01 326
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-10-01 16
2018: HOSPICE OF SURRY RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-10-01 385
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 323
Number of retired or separated participants receiving benefits 2018-10-01 0
Number of other retired or separated participants entitled to future benefits 2018-10-01 123
Total of all active and inactive participants 2018-10-01 446
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-10-01 0
Total participants 2018-10-01 446
Number of participants with account balances 2018-10-01 358
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-10-01 15
2017: HOSPICE OF SURRY RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 322
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 289
Number of retired or separated participants receiving benefits 2017-10-01 0
Number of other retired or separated participants entitled to future benefits 2017-10-01 87
Total of all active and inactive participants 2017-10-01 376
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-10-01 0
Total participants 2017-10-01 376
Number of participants with account balances 2017-10-01 271
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-10-01 8
2016: HOSPICE OF SURRY RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 291
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 274
Number of retired or separated participants receiving benefits 2016-10-01 0
Number of other retired or separated participants entitled to future benefits 2016-10-01 53
Total of all active and inactive participants 2016-10-01 327
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-10-01 0
Total participants 2016-10-01 327
Number of participants with account balances 2016-10-01 221
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-10-01 0
2015: HOSPICE OF SURRY RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 284
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 253
Number of other retired or separated participants entitled to future benefits 2015-10-01 36
Total of all active and inactive participants 2015-10-01 289
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-10-01 0
Total participants 2015-10-01 289
Number of participants with account balances 2015-10-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-10-01 144
2014: HOSPICE OF SURRY RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 264
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 253
Number of other retired or separated participants entitled to future benefits 2014-10-01 27
Total of all active and inactive participants 2014-10-01 280
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-10-01 0
Total participants 2014-10-01 280
Number of participants with account balances 2014-10-01 131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-10-01 3
2013: HOSPICE OF SURRY RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 275
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 213
Number of retired or separated participants receiving benefits 2013-10-01 0
Number of other retired or separated participants entitled to future benefits 2013-10-01 32
Total of all active and inactive participants 2013-10-01 245
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-10-01 0
Total participants 2013-10-01 245
Number of participants with account balances 2013-10-01 118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-10-01 8
2012: HOSPICE OF SURRY RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 274
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 246
Number of retired or separated participants receiving benefits 2012-10-01 0
Number of other retired or separated participants entitled to future benefits 2012-10-01 36
Total of all active and inactive participants 2012-10-01 282
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-10-01 0
Total participants 2012-10-01 282
Number of participants with account balances 2012-10-01 120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-10-01 4
2011: HOSPICE OF SURRY RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 250
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 258
Number of retired or separated participants receiving benefits 2011-10-01 0
Number of other retired or separated participants entitled to future benefits 2011-10-01 27
Total of all active and inactive participants 2011-10-01 285
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-10-01 0
Total participants 2011-10-01 285
Number of participants with account balances 2011-10-01 120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 0
2009: HOSPICE OF SURRY RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 115
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 99
Number of retired or separated participants receiving benefits 2009-10-01 0
Number of other retired or separated participants entitled to future benefits 2009-10-01 8
Total of all active and inactive participants 2009-10-01 107
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-10-01 0
Total participants 2009-10-01 107
Number of participants with account balances 2009-10-01 100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-10-01 0

Measure	Date	Value
2021: HOSPICE OF SURRY RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	427
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	339
Number of retired or separated participants receiving benefits	2021-10-01	28
Number of other retired or separated participants entitled to future benefits	2021-10-01	61
Total of all active and inactive participants	2021-10-01	428
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-10-01	0
Total participants	2021-10-01	428
Number of participants with account balances	2021-10-01	371
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-10-01	33
2020: HOSPICE OF SURRY RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	383
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	322
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	93
Total of all active and inactive participants	2020-10-01	415
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-10-01	0
Total participants	2020-10-01	415
Number of participants with account balances	2020-10-01	366
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-10-01	33
2019: HOSPICE OF SURRY RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	453
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	315
Number of retired or separated participants receiving benefits	2019-10-01	0
Number of other retired or separated participants entitled to future benefits	2019-10-01	64
Total of all active and inactive participants	2019-10-01	379
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-10-01	0
Total participants	2019-10-01	379
Number of participants with account balances	2019-10-01	326
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-10-01	16
2018: HOSPICE OF SURRY RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-10-01	385
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	323
Number of retired or separated participants receiving benefits	2018-10-01	0
Number of other retired or separated participants entitled to future benefits	2018-10-01	123
Total of all active and inactive participants	2018-10-01	446
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-10-01	0
Total participants	2018-10-01	446
Number of participants with account balances	2018-10-01	358
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-10-01	15
2017: HOSPICE OF SURRY RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	322
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	289
Number of retired or separated participants receiving benefits	2017-10-01	0
Number of other retired or separated participants entitled to future benefits	2017-10-01	87
Total of all active and inactive participants	2017-10-01	376
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-10-01	0
Total participants	2017-10-01	376
Number of participants with account balances	2017-10-01	271
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-10-01	8
2016: HOSPICE OF SURRY RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	291
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	274
Number of retired or separated participants receiving benefits	2016-10-01	0
Number of other retired or separated participants entitled to future benefits	2016-10-01	53
Total of all active and inactive participants	2016-10-01	327
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-10-01	0
Total participants	2016-10-01	327
Number of participants with account balances	2016-10-01	221
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-10-01	0
2015: HOSPICE OF SURRY RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	284
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	253
Number of other retired or separated participants entitled to future benefits	2015-10-01	36
Total of all active and inactive participants	2015-10-01	289
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-10-01	0
Total participants	2015-10-01	289
Number of participants with account balances	2015-10-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-10-01	144
2014: HOSPICE OF SURRY RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	264
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	253
Number of other retired or separated participants entitled to future benefits	2014-10-01	27
Total of all active and inactive participants	2014-10-01	280
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-10-01	0
Total participants	2014-10-01	280
Number of participants with account balances	2014-10-01	131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-10-01	3
2013: HOSPICE OF SURRY RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	275
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	213
Number of retired or separated participants receiving benefits	2013-10-01	0
Number of other retired or separated participants entitled to future benefits	2013-10-01	32
Total of all active and inactive participants	2013-10-01	245
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-10-01	0
Total participants	2013-10-01	245
Number of participants with account balances	2013-10-01	118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-10-01	8
2012: HOSPICE OF SURRY RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	274
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	246
Number of retired or separated participants receiving benefits	2012-10-01	0
Number of other retired or separated participants entitled to future benefits	2012-10-01	36
Total of all active and inactive participants	2012-10-01	282
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-10-01	0
Total participants	2012-10-01	282
Number of participants with account balances	2012-10-01	120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-10-01	4
2011: HOSPICE OF SURRY RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	250
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	258
Number of retired or separated participants receiving benefits	2011-10-01	0
Number of other retired or separated participants entitled to future benefits	2011-10-01	27
Total of all active and inactive participants	2011-10-01	285
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-10-01	0
Total participants	2011-10-01	285
Number of participants with account balances	2011-10-01	120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	0
2009: HOSPICE OF SURRY RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	115
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	99
Number of retired or separated participants receiving benefits	2009-10-01	0
Number of other retired or separated participants entitled to future benefits	2009-10-01	8
Total of all active and inactive participants	2009-10-01	107
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-10-01	0
Total participants	2009-10-01	107
Number of participants with account balances	2009-10-01	100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-10-01	0

Financial Data on HOSPICE OF SURRY RETIREMENT PLAN

Measure	Date	Value
2022 : HOSPICE OF SURRY RETIREMENT PLAN 2022 401k financial data
Total income from all sources (including contributions)	2022-09-30	$250,788
Total of all expenses incurred	2022-09-30	$1,422,445
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-09-30	$1,347,720
Expenses. Certain deemed distributions of participant loans	2022-09-30	$4,201
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-09-30	$1,180,861
Value of total assets at end of year	2022-09-30	$5,107,229
Value of total assets at beginning of year	2022-09-30	$6,278,886
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-09-30	$70,524
Total interest from all sources	2022-09-30	$5,502
Total dividends received (eg from common stock, registered investment company shares)	2022-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-09-30	$0
Was this plan covered by a fidelity bond	2022-09-30	Yes
Value of fidelity bond cover	2022-09-30	$500,000
If this is an individual account plan, was there a blackout period	2022-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2022-09-30	No
Contributions received from participants	2022-09-30	$917,432
Participant contributions at end of year	2022-09-30	$115,063
Participant contributions at beginning of year	2022-09-30	$103,881
Participant contributions at end of year	2022-09-30	$0
Participant contributions at beginning of year	2022-09-30	$0
Income. Received or receivable in cash from other sources (including rollovers)	2022-09-30	$46,968
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-09-30	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-09-30	$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	2022-09-30	No
Value of net income/loss	2022-09-30	$-1,171,657
Value of net assets at end of year (total assets less liabilities)	2022-09-30	$5,107,229
Value of net assets at beginning of year (total assets less liabilities)	2022-09-30	$6,278,886
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-09-30	No
Were any leases to which the plan was party in default or uncollectible	2022-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-09-30	$4,385,113
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-09-30	$5,177,012
Interest on participant loans	2022-09-30	$5,502
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-09-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-09-30	$607,053
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-09-30	$997,993
Expenses. Payments to insurance carriers foe the provision of benefits	2022-09-30	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-09-30	$-935,575
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-09-30	No
Was there a failure to transmit to the plan any participant contributions	2022-09-30	No
Has the plan failed to provide any benefit when due under the plan	2022-09-30	No
Contributions received in cash from employer	2022-09-30	$216,461
Employer contributions (assets) at end of year	2022-09-30	$0
Employer contributions (assets) at beginning of year	2022-09-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-09-30	$1,347,720
Contract administrator fees	2022-09-30	$70,524
Did the plan have assets held for investment	2022-09-30	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	2022-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-09-30	No
Opinion of an independent qualified public accountant for this plan	2022-09-30	Disclaimer
Accountancy firm name	2022-09-30	FORVIS, LLP
Accountancy firm EIN	2022-09-30	440160260
2021 : HOSPICE OF SURRY RETIREMENT PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-09-30	$2,068,924
Total of all expenses incurred	2021-09-30	$614,501
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-09-30	$556,434
Expenses. Certain deemed distributions of participant loans	2021-09-30	$0
Value of total corrective distributions	2021-09-30	$360
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-09-30	$1,321,875
Value of total assets at end of year	2021-09-30	$6,278,886
Value of total assets at beginning of year	2021-09-30	$4,824,463
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-09-30	$57,707
Total interest from all sources	2021-09-30	$4,943
Total dividends received (eg from common stock, registered investment company shares)	2021-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-09-30	$0
Was this plan covered by a fidelity bond	2021-09-30	Yes
Value of fidelity bond cover	2021-09-30	$500,000
If this is an individual account plan, was there a blackout period	2021-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2021-09-30	No
Contributions received from participants	2021-09-30	$783,213
Participant contributions at end of year	2021-09-30	$103,881
Participant contributions at beginning of year	2021-09-30	$115,968
Participant contributions at end of year	2021-09-30	$0
Income. Received or receivable in cash from other sources (including rollovers)	2021-09-30	$343,390
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-09-30	$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	2021-09-30	No
Value of net income/loss	2021-09-30	$1,454,423
Value of net assets at end of year (total assets less liabilities)	2021-09-30	$6,278,886
Value of net assets at beginning of year (total assets less liabilities)	2021-09-30	$4,824,463
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-09-30	No
Were any leases to which the plan was party in default or uncollectible	2021-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-09-30	$5,177,012
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-09-30	$3,326,725
Interest on participant loans	2021-09-30	$4,943
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-09-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-09-30	$997,993
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-09-30	$1,381,770
Expenses. Payments to insurance carriers foe the provision of benefits	2021-09-30	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-09-30	$742,106
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-09-30	No
Was there a failure to transmit to the plan any participant contributions	2021-09-30	Yes
Has the plan failed to provide any benefit when due under the plan	2021-09-30	No
Contributions received in cash from employer	2021-09-30	$195,272
Employer contributions (assets) at end of year	2021-09-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-09-30	$556,434
Contract administrator fees	2021-09-30	$57,707
Did the plan have assets held for investment	2021-09-30	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	2021-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-09-30	No
Opinion of an independent qualified public accountant for this plan	2021-09-30	Disclaimer
Accountancy firm name	2021-09-30	FORVIS, LLP
Accountancy firm EIN	2021-09-30	440160260
2020 : HOSPICE OF SURRY RETIREMENT PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-09-30	$1,178,339
Total of all expenses incurred	2020-09-30	$1,533,352
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-09-30	$1,489,305
Expenses. Certain deemed distributions of participant loans	2020-09-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-09-30	$842,956
Value of total assets at end of year	2020-09-30	$4,824,463
Value of total assets at beginning of year	2020-09-30	$5,179,476
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-09-30	$44,047
Total interest from all sources	2020-09-30	$3,635
Total dividends received (eg from common stock, registered investment company shares)	2020-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-09-30	$0
Was this plan covered by a fidelity bond	2020-09-30	Yes
Value of fidelity bond cover	2020-09-30	$500,000
If this is an individual account plan, was there a blackout period	2020-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2020-09-30	No
Contributions received from participants	2020-09-30	$662,302
Participant contributions at end of year	2020-09-30	$115,968
Participant contributions at beginning of year	2020-09-30	$62,239
Income. Received or receivable in cash from other sources (including rollovers)	2020-09-30	$38,362
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-09-30	No
Value of net income/loss	2020-09-30	$-355,013
Value of net assets at end of year (total assets less liabilities)	2020-09-30	$4,824,463
Value of net assets at beginning of year (total assets less liabilities)	2020-09-30	$5,179,476
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-09-30	No
Were any leases to which the plan was party in default or uncollectible	2020-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-09-30	$3,326,725
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-09-30	$2,815,595
Interest on participant loans	2020-09-30	$3,635
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-09-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-09-30	$1,381,770
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-09-30	$2,301,642
Expenses. Payments to insurance carriers foe the provision of benefits	2020-09-30	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-09-30	$331,748
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-09-30	No
Was there a failure to transmit to the plan any participant contributions	2020-09-30	Yes
Has the plan failed to provide any benefit when due under the plan	2020-09-30	No
Contributions received in cash from employer	2020-09-30	$142,292
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-09-30	$1,489,305
Contract administrator fees	2020-09-30	$44,047
Did the plan have assets held for investment	2020-09-30	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	2020-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2020-09-30	Disclaimer
Accountancy firm name	2020-09-30	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2020-09-30	560747981
2019 : HOSPICE OF SURRY RETIREMENT PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-09-30	$643,101
Total of all expenses incurred	2019-09-30	$595,657
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-09-30	$594,845
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-09-30	$631,004
Value of total assets at end of year	2019-09-30	$5,179,476
Value of total assets at beginning of year	2019-09-30	$5,132,032
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-09-30	$812
Total interest from all sources	2019-09-30	$47,795
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-09-30	No
Was this plan covered by a fidelity bond	2019-09-30	Yes
Value of fidelity bond cover	2019-09-30	$65,000
If this is an individual account plan, was there a blackout period	2019-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2019-09-30	No
Contributions received from participants	2019-09-30	$491,632
Participant contributions at end of year	2019-09-30	$62,239
Participant contributions at beginning of year	2019-09-30	$36,492
Income. Received or receivable in cash from other sources (including rollovers)	2019-09-30	$15,511
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-09-30	No
Value of net income/loss	2019-09-30	$47,444
Value of net assets at end of year (total assets less liabilities)	2019-09-30	$5,179,476
Value of net assets at beginning of year (total assets less liabilities)	2019-09-30	$5,132,032
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-09-30	No
Were any leases to which the plan was party in default or uncollectible	2019-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-09-30	$2,815,595
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-09-30	$2,833,473
Interest on participant loans	2019-09-30	$1,593
Interest earned on other investments	2019-09-30	$46,202
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-09-30	$2,301,642
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-09-30	$2,262,067
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-09-30	$-35,698
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-09-30	No
Was there a failure to transmit to the plan any participant contributions	2019-09-30	No
Has the plan failed to provide any benefit when due under the plan	2019-09-30	No
Contributions received in cash from employer	2019-09-30	$123,861
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-09-30	$594,845
Contract administrator fees	2019-09-30	$812
Did the plan have assets held for investment	2019-09-30	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	2019-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2019-09-30	Disclaimer
Accountancy firm name	2019-09-30	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2019-09-30	560747981
2018 : HOSPICE OF SURRY RETIREMENT PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-09-30	$992,664
Total of all expenses incurred	2018-09-30	$186,289
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-09-30	$185,526
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-09-30	$694,915
Value of total assets at end of year	2018-09-30	$5,132,032
Value of total assets at beginning of year	2018-09-30	$4,325,657
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-09-30	$763
Total interest from all sources	2018-09-30	$44,261
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-09-30	No
Was this plan covered by a fidelity bond	2018-09-30	Yes
Value of fidelity bond cover	2018-09-30	$65,000
If this is an individual account plan, was there a blackout period	2018-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2018-09-30	No
Contributions received from participants	2018-09-30	$463,127
Participant contributions at end of year	2018-09-30	$36,492
Participant contributions at beginning of year	2018-09-30	$23,833
Income. Received or receivable in cash from other sources (including rollovers)	2018-09-30	$120,507
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-09-30	No
Value of net income/loss	2018-09-30	$806,375
Value of net assets at end of year (total assets less liabilities)	2018-09-30	$5,132,032
Value of net assets at beginning of year (total assets less liabilities)	2018-09-30	$4,325,657
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-09-30	No
Were any leases to which the plan was party in default or uncollectible	2018-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-09-30	$2,833,473
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-09-30	$2,106,963
Interest on participant loans	2018-09-30	$1,165
Interest earned on other investments	2018-09-30	$43,096
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-09-30	$2,262,067
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-09-30	$2,194,861
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-09-30	$253,488
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-09-30	No
Was there a failure to transmit to the plan any participant contributions	2018-09-30	No
Has the plan failed to provide any benefit when due under the plan	2018-09-30	No
Contributions received in cash from employer	2018-09-30	$111,281
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-09-30	$185,526
Contract administrator fees	2018-09-30	$763
Did the plan have assets held for investment	2018-09-30	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	2018-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2018-09-30	Disclaimer
Accountancy firm name	2018-09-30	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2018-09-30	560747981
2017 : HOSPICE OF SURRY RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-09-30	$0
Total income from all sources (including contributions)	2017-09-30	$820,905
Total loss/gain on sale of assets	2017-09-30	$0
Total of all expenses incurred	2017-09-30	$276,532
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-09-30	$274,484
Expenses. Certain deemed distributions of participant loans	2017-09-30	$0
Value of total corrective distributions	2017-09-30	$928
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-09-30	$512,448
Value of total assets at end of year	2017-09-30	$4,325,657
Value of total assets at beginning of year	2017-09-30	$3,781,284
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-09-30	$1,120
Total interest from all sources	2017-09-30	$42,076
Total dividends received (eg from common stock, registered investment company shares)	2017-09-30	$0
Was this plan covered by a fidelity bond	2017-09-30	Yes
Value of fidelity bond cover	2017-09-30	$65,000
If this is an individual account plan, was there a blackout period	2017-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2017-09-30	No
Contributions received from participants	2017-09-30	$392,381
Participant contributions at end of year	2017-09-30	$23,833
Participant contributions at beginning of year	2017-09-30	$32,150
Income. Received or receivable in cash from other sources (including rollovers)	2017-09-30	$26,985
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-09-30	No
Value of net income/loss	2017-09-30	$544,373
Value of net assets at end of year (total assets less liabilities)	2017-09-30	$4,325,657
Value of net assets at beginning of year (total assets less liabilities)	2017-09-30	$3,781,284
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-09-30	No
Were any leases to which the plan was party in default or uncollectible	2017-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-09-30	$2,106,963
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-09-30	$1,700,275
Interest on participant loans	2017-09-30	$920
Interest earned on other investments	2017-09-30	$41,156
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-09-30	$2,194,861
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-09-30	$2,048,859
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-09-30	$266,381
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-09-30	No
Was there a failure to transmit to the plan any participant contributions	2017-09-30	No
Has the plan failed to provide any benefit when due under the plan	2017-09-30	No
Contributions received in cash from employer	2017-09-30	$93,082
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-09-30	$274,484
Contract administrator fees	2017-09-30	$1,120
Did the plan have assets held for investment	2017-09-30	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	2017-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2017-09-30	Disclaimer
Accountancy firm name	2017-09-30	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2017-09-30	560747981
2016 : HOSPICE OF SURRY RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-09-30	$0
Total income from all sources (including contributions)	2016-09-30	$722,384
Total loss/gain on sale of assets	2016-09-30	$0
Total of all expenses incurred	2016-09-30	$188,520
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-09-30	$184,191
Expenses. Certain deemed distributions of participant loans	2016-09-30	$3,444
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-09-30	$517,414
Value of total assets at end of year	2016-09-30	$3,781,284
Value of total assets at beginning of year	2016-09-30	$3,247,420
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-09-30	$885
Total interest from all sources	2016-09-30	$39,249
Total dividends received (eg from common stock, registered investment company shares)	2016-09-30	$0
Was this plan covered by a fidelity bond	2016-09-30	Yes
Value of fidelity bond cover	2016-09-30	$65,000
If this is an individual account plan, was there a blackout period	2016-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2016-09-30	No
Contributions received from participants	2016-09-30	$415,774
Participant contributions at end of year	2016-09-30	$32,150
Participant contributions at beginning of year	2016-09-30	$47,416
Income. Received or receivable in cash from other sources (including rollovers)	2016-09-30	$11,114
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-09-30	No
Value of net income/loss	2016-09-30	$533,864
Value of net assets at end of year (total assets less liabilities)	2016-09-30	$3,781,284
Value of net assets at beginning of year (total assets less liabilities)	2016-09-30	$3,247,420
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-09-30	No
Were any leases to which the plan was party in default or uncollectible	2016-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-09-30	$1,700,275
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-09-30	$1,311,004
Interest on participant loans	2016-09-30	$1,275
Interest earned on other investments	2016-09-30	$37,974
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-09-30	$2,048,859
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-09-30	$1,889,000
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-09-30	$165,721
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-09-30	No
Was there a failure to transmit to the plan any participant contributions	2016-09-30	No
Has the plan failed to provide any benefit when due under the plan	2016-09-30	No
Contributions received in cash from employer	2016-09-30	$90,526
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-09-30	$184,191
Contract administrator fees	2016-09-30	$885
Did the plan have assets held for investment	2016-09-30	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	2016-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2016-09-30	Disclaimer
Accountancy firm name	2016-09-30	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2016-09-30	560747981
2015 : HOSPICE OF SURRY RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-09-30	$0
Total income from all sources (including contributions)	2015-09-30	$433,340
Total loss/gain on sale of assets	2015-09-30	$0
Total of all expenses incurred	2015-09-30	$349,738
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-09-30	$345,197
Expenses. Certain deemed distributions of participant loans	2015-09-30	$108
Value of total corrective distributions	2015-09-30	$2,706
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-09-30	$419,925
Value of total assets at end of year	2015-09-30	$3,247,420
Value of total assets at beginning of year	2015-09-30	$3,163,818
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-09-30	$1,727
Total interest from all sources	2015-09-30	$38,480
Total dividends received (eg from common stock, registered investment company shares)	2015-09-30	$0
Was this plan covered by a fidelity bond	2015-09-30	Yes
Value of fidelity bond cover	2015-09-30	$65,000
If this is an individual account plan, was there a blackout period	2015-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2015-09-30	No
Contributions received from participants	2015-09-30	$343,324
Participant contributions at end of year	2015-09-30	$47,416
Participant contributions at beginning of year	2015-09-30	$56,083
Income. Received or receivable in cash from other sources (including rollovers)	2015-09-30	$8,127
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-09-30	No
Value of net income/loss	2015-09-30	$83,602
Value of net assets at end of year (total assets less liabilities)	2015-09-30	$3,247,420
Value of net assets at beginning of year (total assets less liabilities)	2015-09-30	$3,163,818
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-09-30	No
Were any leases to which the plan was party in default or uncollectible	2015-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-09-30	$1,311,004
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-09-30	$1,248,138
Interest on participant loans	2015-09-30	$1,511
Interest earned on other investments	2015-09-30	$36,969
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-09-30	$1,889,000
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-09-30	$1,859,597
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-09-30	$-25,065
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-09-30	No
Was there a failure to transmit to the plan any participant contributions	2015-09-30	No
Has the plan failed to provide any benefit when due under the plan	2015-09-30	No
Contributions received in cash from employer	2015-09-30	$68,474
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-09-30	$345,197
Contract administrator fees	2015-09-30	$1,727
Did the plan have assets held for investment	2015-09-30	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	2015-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2015-09-30	Disclaimer
Accountancy firm name	2015-09-30	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2015-09-30	560747981
2014 : HOSPICE OF SURRY RETIREMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-09-30	$0
Total income from all sources (including contributions)	2014-09-30	$518,132
Total loss/gain on sale of assets	2014-09-30	$0
Total of all expenses incurred	2014-09-30	$103,007
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-09-30	$92,653
Expenses. Certain deemed distributions of participant loans	2014-09-30	$9,691
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-09-30	$371,662
Value of total assets at end of year	2014-09-30	$3,163,818
Value of total assets at beginning of year	2014-09-30	$2,748,693
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-09-30	$663
Total interest from all sources	2014-09-30	$37,761
Total dividends received (eg from common stock, registered investment company shares)	2014-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-09-30	No
Administrative expenses professional fees incurred	2014-09-30	$663
Was this plan covered by a fidelity bond	2014-09-30	Yes
Value of fidelity bond cover	2014-09-30	$65,000
If this is an individual account plan, was there a blackout period	2014-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2014-09-30	No
Contributions received from participants	2014-09-30	$301,103
Income. Received or receivable in cash from other sources (including rollovers)	2014-09-30	$2,337
Assets. Loans (other than to participants) at end of year	2014-09-30	$56,083
Assets. Loans (other than to participants) at beginning of year	2014-09-30	$56,465
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-09-30	No
Value of net income/loss	2014-09-30	$415,125
Value of net assets at end of year (total assets less liabilities)	2014-09-30	$3,163,818
Value of net assets at beginning of year (total assets less liabilities)	2014-09-30	$2,748,693
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-09-30	No
Were any leases to which the plan was party in default or uncollectible	2014-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-09-30	$1,248,138
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-09-30	$972,199
Interest on participant loans	2014-09-30	$1,859
Interest earned on other investments	2014-09-30	$35,902
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-09-30	$1,859,597
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-09-30	$1,720,029
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-09-30	$108,709
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-09-30	No
Was there a failure to transmit to the plan any participant contributions	2014-09-30	No
Has the plan failed to provide any benefit when due under the plan	2014-09-30	No
Contributions received in cash from employer	2014-09-30	$68,222
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-09-30	$92,653
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	2014-09-30	No
Did the plan have assets held for investment	2014-09-30	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	2014-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2014-09-30	Disclaimer
Accountancy firm name	2014-09-30	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2014-09-30	560747981
2013 : HOSPICE OF SURRY RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-09-30	$0
Total income from all sources (including contributions)	2013-09-30	$561,587
Total loss/gain on sale of assets	2013-09-30	$0
Total of all expenses incurred	2013-09-30	$301,698
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-09-30	$291,932
Expenses. Certain deemed distributions of participant loans	2013-09-30	$9,478
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-09-30	$374,219
Value of total assets at end of year	2013-09-30	$2,748,693
Value of total assets at beginning of year	2013-09-30	$2,488,804
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-09-30	$288
Total interest from all sources	2013-09-30	$38,196
Total dividends received (eg from common stock, registered investment company shares)	2013-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-09-30	No
Was this plan covered by a fidelity bond	2013-09-30	Yes
Value of fidelity bond cover	2013-09-30	$65,000
If this is an individual account plan, was there a blackout period	2013-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2013-09-30	No
Contributions received from participants	2013-09-30	$305,728
Assets. Loans (other than to participants) at end of year	2013-09-30	$56,465
Assets. Loans (other than to participants) at beginning of year	2013-09-30	$73,467
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-09-30	No
Value of net income/loss	2013-09-30	$259,889
Value of net assets at end of year (total assets less liabilities)	2013-09-30	$2,748,693
Value of net assets at beginning of year (total assets less liabilities)	2013-09-30	$2,488,804
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-09-30	No
Were any leases to which the plan was party in default or uncollectible	2013-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-09-30	$972,199
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-09-30	$681,747
Interest on participant loans	2013-09-30	$2,033
Interest earned on other investments	2013-09-30	$36,163
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-09-30	$1,720,029
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-09-30	$1,733,590
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-09-30	$149,172
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-09-30	No
Was there a failure to transmit to the plan any participant contributions	2013-09-30	No
Has the plan failed to provide any benefit when due under the plan	2013-09-30	No
Contributions received in cash from employer	2013-09-30	$68,491
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-09-30	$291,932
Contract administrator fees	2013-09-30	$288
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	2013-09-30	No
Did the plan have assets held for investment	2013-09-30	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	2013-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2013-09-30	Disclaimer
Accountancy firm name	2013-09-30	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2013-09-30	560747981
2012 : HOSPICE OF SURRY RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$0
Total income from all sources (including contributions)	2012-09-30	$497,871
Total loss/gain on sale of assets	2012-09-30	$0
Total of all expenses incurred	2012-09-30	$21,407
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-09-30	$19,157
Expenses. Certain deemed distributions of participant loans	2012-09-30	$2,040
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-09-30	$334,838
Value of total assets at end of year	2012-09-30	$2,488,804
Value of total assets at beginning of year	2012-09-30	$2,012,340
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-09-30	$210
Total interest from all sources	2012-09-30	$43,574
Total dividends received (eg from common stock, registered investment company shares)	2012-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-09-30	No
Was this plan covered by a fidelity bond	2012-09-30	No
If this is an individual account plan, was there a blackout period	2012-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2012-09-30	No
Contributions received from participants	2012-09-30	$267,696
Income. Received or receivable in cash from other sources (including rollovers)	2012-09-30	$5,869
Assets. Loans (other than to participants) at end of year	2012-09-30	$73,467
Assets. Loans (other than to participants) at beginning of year	2012-09-30	$17,934
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-09-30	No
Value of net income/loss	2012-09-30	$476,464
Value of net assets at end of year (total assets less liabilities)	2012-09-30	$2,488,804
Value of net assets at beginning of year (total assets less liabilities)	2012-09-30	$2,012,340
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-09-30	No
Were any leases to which the plan was party in default or uncollectible	2012-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-09-30	$681,747
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-09-30	$469,259
Interest on participant loans	2012-09-30	$833
Interest earned on other investments	2012-09-30	$42,741
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-09-30	$1,733,590
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-09-30	$1,525,147
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-09-30	$119,459
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-09-30	No
Was there a failure to transmit to the plan any participant contributions	2012-09-30	No
Has the plan failed to provide any benefit when due under the plan	2012-09-30	No
Contributions received in cash from employer	2012-09-30	$61,273
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-09-30	$19,157
Contract administrator fees	2012-09-30	$210
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	2012-09-30	No
Did the plan have assets held for investment	2012-09-30	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	2012-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-09-30	Disclaimer
Accountancy firm name	2012-09-30	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2012-09-30	560747981
2011 : HOSPICE OF SURRY RETIREMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$0
Expenses. Interest paid	2011-09-30	$9,681
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2011-09-30	$9,681
Total income from all sources (including contributions)	2011-09-30	$364,851
Total loss/gain on sale of assets	2011-09-30	$0
Total of all expenses incurred	2011-09-30	$75,505
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-09-30	$65,655
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-09-30	$334,641
Value of total assets at end of year	2011-09-30	$2,012,340
Value of total assets at beginning of year	2011-09-30	$1,722,994
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-09-30	$169
Total interest from all sources	2011-09-30	$47,752
Total dividends received (eg from common stock, registered investment company shares)	2011-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-09-30	No
Was this plan covered by a fidelity bond	2011-09-30	No
If this is an individual account plan, was there a blackout period	2011-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2011-09-30	No
Contributions received from participants	2011-09-30	$272,682
Assets. Loans (other than to participants) at end of year	2011-09-30	$17,934
Assets. Loans (other than to participants) at beginning of year	2011-09-30	$19,465
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-09-30	No
Value of net income/loss	2011-09-30	$289,346
Value of net assets at end of year (total assets less liabilities)	2011-09-30	$2,012,340
Value of net assets at beginning of year (total assets less liabilities)	2011-09-30	$1,722,994
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-09-30	No
Were any leases to which the plan was party in default or uncollectible	2011-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-09-30	$469,259
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-09-30	$436,076
Interest on participant loans	2011-09-30	$720
Interest earned on other investments	2011-09-30	$47,032
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-09-30	$1,525,147
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-09-30	$1,267,453
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-09-30	$-17,542
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-09-30	No
Was there a failure to transmit to the plan any participant contributions	2011-09-30	Yes
Has the plan failed to provide any benefit when due under the plan	2011-09-30	No
Contributions received in cash from employer	2011-09-30	$61,959
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-09-30	$65,655
Contract administrator fees	2011-09-30	$169
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-09-30	No
Did the plan have assets held for investment	2011-09-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-09-30	Disclaimer
Accountancy firm name	2011-09-30	DIXON HUGHES GOODMAN LLP
Accountancy firm EIN	2011-09-30	560747981
2010 : HOSPICE OF SURRY RETIREMENT PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-09-30	$0

Form 5500 Responses for HOSPICE OF SURRY RETIREMENT PLAN

2021: HOSPICE OF SURRY RETIREMENT PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2020: HOSPICE OF SURRY RETIREMENT PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2019: HOSPICE OF SURRY RETIREMENT PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – Insurance	Yes
2018: HOSPICE OF SURRY RETIREMENT PLAN 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
2018-10-01	Plan funding arrangement – Insurance	Yes
2018-10-01	Plan benefit arrangement – Insurance	Yes
2017: HOSPICE OF SURRY RETIREMENT PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2016: HOSPICE OF SURRY RETIREMENT PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2015: HOSPICE OF SURRY RETIREMENT PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2014: HOSPICE OF SURRY RETIREMENT PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2013: HOSPICE OF SURRY RETIREMENT PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2012: HOSPICE OF SURRY RETIREMENT PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2011: HOSPICE OF SURRY RETIREMENT PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2009: HOSPICE OF SURRY RETIREMENT PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes
2008: HOSPICE OF SURRY RETIREMENT PLAN 2008 form 5500 responses
2008-10-01	Type of plan entity	Single employer plan
2008-10-01	Submission has been amended	No
2008-10-01	This submission is the final filing	No
2008-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-10-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

67845

Policy instance

Insurance contract or identification number	67845
Number of Individuals Covered	71
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $109
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $109
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	401
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $50
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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	50
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	5

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

67845

Policy instance

Insurance contract or identification number	67845
Number of Individuals Covered	79
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $207
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $192
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	424
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of fees paid to insurance company	USD $34
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	34
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	5

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	469
Insurance policy start date	2019-11-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $15
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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	15
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	5

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

67845

Policy instance

Insurance contract or identification number	67845
Number of Individuals Covered	84
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

67845

Policy instance

Insurance contract or identification number	67845
Number of Individuals Covered	365
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $10,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,539
Insurance broker organization code?	3

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

67845

Policy instance

Insurance contract or identification number	67845
Number of Individuals Covered	275
Total amount of commissions paid to insurance broker	USD $11,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

67845

Policy instance

Insurance contract or identification number	67845
Insurance policy start date	2017-10-01
Insurance policy end date	2018-09-30
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VARIABLE ANNUITY LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

67845

Policy instance

Insurance contract or identification number	67845
Number of Individuals Covered	123
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $5,915
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
Commission paid to Insurance Broker	USD $5,355
Insurance broker organization code?	3
Insurance broker name	SCHULTZ, MICHAEL J

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

67845

Policy instance

Insurance contract or identification number	67845
Number of Individuals Covered	114
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $3,784
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	1
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 $3,413
Insurance broker organization code?	3
Insurance broker name	ARON JR, A. MACAULEY

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

67845

Policy instance

Insurance contract or identification number	67845
Number of Individuals Covered	121
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $3,974
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	1
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 $3,564
Insurance broker organization code?	3
Insurance broker name	ARON JR, A. MACAULEY

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

67845

Policy instance

Insurance contract or identification number	67845
Number of Individuals Covered	121
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $3,836
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	1
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

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

67845

Policy instance

Insurance contract or identification number	67845
Number of Individuals Covered	115
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $4,754
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	1
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

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Company Name:	HOSPICE OF SURRY, INC.
Employer identification number (EIN):	561346584
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities