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CUSTOM HOME CARE 401(K) PLAN 401k Plan overview

Plan NameCUSTOM HOME CARE 401(K) PLAN
Plan identification number 001

CUSTOM HOME CARE 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

CUSTOM HOME CARE, LLC has sponsored the creation of one or more 401k plans.

Company Name:CUSTOM HOME CARE, LLC
Employer identification number (EIN):813987907
NAIC Classification:621610
NAIC Description:Home Health Care Services

Form 5500 Filing Information

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

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012017-04-01TAMARA JACKSON TAMARA JACKSON2018-10-15

Plan Statistics for CUSTOM HOME CARE 401(K) PLAN

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

Measure Date Value
2017: CUSTOM HOME CARE 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01268
Total number of active participants reported on line 7a of the Form 55002017-04-01268
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01268
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-04-010
Total participants2017-04-01268
Number of participants with account balances2017-04-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-04-010

Financial Data on CUSTOM HOME CARE 401(K) PLAN

Measure Date Value
2017 : CUSTOM HOME CARE 401(K) PLAN 2017 401k financial data
Unrealized appreciation/depreciation of real estate assets2017-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2017-12-31$0
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total transfer of assets to this plan2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$30,794
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$0
Value of total corrective distributions2017-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$30,167
Value of total assets at end of year2017-12-31$30,794
Value of total assets at beginning of year2017-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$0
Total income from rents2017-12-31$0
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$0
Administrative expenses professional fees incurred2017-12-31$0
Was this plan covered by a fidelity bond2017-12-31No
Value of fidelity bond cover2017-12-31$0
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Amount of non-exempt transactions with any party-in-interest2017-12-31$0
Contributions received from participants2017-12-31$10,026
Participant contributions at end of year2017-12-31$0
Participant contributions at beginning of year2017-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$20,141
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$0
Other income not declared elsewhere2017-12-31$0
Administrative expenses (other) incurred2017-12-31$0
Liabilities. Value of operating payables at beginning of year2017-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$30,794
Value of net assets at end of year (total assets less liabilities)2017-12-31$30,794
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2017-12-31$0
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2017-12-31$0
Investment advisory and management fees2017-12-31$0
Value of interest in pooled separate accounts at end of year2017-12-31$0
Value of interest in pooled separate accounts at beginning of year2017-12-31$0
Income. Interest from loans (other than to participants)2017-12-31$0
Interest earned on other investments2017-12-31$0
Income. Interest from US Government securities2017-12-31$0
Income. Interest from corporate debt instruments2017-12-31$0
Value of interest in common/collective trusts at end of year2017-12-31$30,794
Value of interest in common/collective trusts at beginning of year2017-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$0
Net investment gain/loss from pooled separate accounts2017-12-31$0
Net investment gain or loss from common/collective trusts2017-12-31$627
Net gain/loss from 103.12 investment entities2017-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31Yes
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$0
Employer contributions (assets) at end of year2017-12-31$0
Employer contributions (assets) at beginning of year2017-12-31$0
Income. Dividends from preferred stock2017-12-31$0
Income. Dividends from common stock2017-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$0
Contract administrator fees2017-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$0
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Aggregate proceeds on sale of assets2017-12-31$0
Aggregate carrying amount (costs) on sale of assets2017-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2017-12-31$0

Form 5500 Responses for CUSTOM HOME CARE 401(K) PLAN

2017: CUSTOM HOME CARE 401(K) PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01First time form 5500 has been submittedYes
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – TrustYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number814611
Policy instance 1
Insurance contract or identification number814611
Number of Individuals Covered268
Insurance policy start date2017-04-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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