401k Plan data: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN plan

CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 401k Plan overview

Plan Name	CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN
Plan identification number	001

CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

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

Company Name: CHARTER HOSPICE, INC.

Employer identification number (EIN): 870742297

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01
001 2018-01-01
001 2017-01-01 FELISA MARTIN FELISA MARTIN 2018-10-15
001 2016-01-01 FELISA MARTIN FELISA MARTIN 2017-10-16
001 2015-01-01 FELISA MARTIN FELISA MARTIN 2016-10-15
001 2014-01-01 SHARON WAKE FELISA MARTIN 2015-10-14
001 2013-01-01 SHARON WAKE FELISA MARTIN 2014-10-15
001 2012-01-01 SHARON WAKE FELISA MARTIN 2013-10-15

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2019-01-01
001	2018-01-01
001	2017-01-01	FELISA MARTIN	FELISA MARTIN	2018-10-15
001	2016-01-01	FELISA MARTIN	FELISA MARTIN	2017-10-16
001	2015-01-01	FELISA MARTIN	FELISA MARTIN	2016-10-15
001	2014-01-01	SHARON WAKE	FELISA MARTIN	2015-10-14
001	2013-01-01	SHARON WAKE	FELISA MARTIN	2014-10-15
001	2012-01-01	SHARON WAKE	FELISA MARTIN	2013-10-15

Plan Statistics for CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN

401k plan membership statisitcs for CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN

Measure Date Value
2019: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 0
Number of participants with account balances 2019-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 108
Number of retired or separated participants receiving benefits 2018-01-01 71
Number of other retired or separated participants entitled to future benefits 2018-01-01 4
Total of all active and inactive participants 2018-01-01 183
Total participants 2018-01-01 183
Number of participants with account balances 2018-01-01 176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 68
Number of retired or separated participants receiving benefits 2017-01-01 5
Number of other retired or separated participants entitled to future benefits 2017-01-01 160
Total of all active and inactive participants 2017-01-01 233
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 233
Number of participants with account balances 2017-01-01 228
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 88
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 38
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 280
Total of all active and inactive participants 2016-01-01 318
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 318
Number of participants with account balances 2016-01-01 289
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 84
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 30
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 37
Total of all active and inactive participants 2015-01-01 67
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 67
Number of participants with account balances 2015-01-01 75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 29
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 17
Total of all active and inactive participants 2014-01-01 46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 46
Number of participants with account balances 2014-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 77
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 104
Total of all active and inactive participants 2013-01-01 181
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 181
Number of participants with account balances 2013-01-01 143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 45
2012: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 180
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 229
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 6
Total of all active and inactive participants 2012-01-01 235
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 235
Number of participants with account balances 2012-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2019: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	0
Number of participants with account balances	2019-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	108
Number of retired or separated participants receiving benefits	2018-01-01	71
Number of other retired or separated participants entitled to future benefits	2018-01-01	4
Total of all active and inactive participants	2018-01-01	183
Total participants	2018-01-01	183
Number of participants with account balances	2018-01-01	176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	68
Number of retired or separated participants receiving benefits	2017-01-01	5
Number of other retired or separated participants entitled to future benefits	2017-01-01	160
Total of all active and inactive participants	2017-01-01	233
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	233
Number of participants with account balances	2017-01-01	228
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	88
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	38
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	280
Total of all active and inactive participants	2016-01-01	318
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	318
Number of participants with account balances	2016-01-01	289
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	84
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	30
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	37
Total of all active and inactive participants	2015-01-01	67
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	67
Number of participants with account balances	2015-01-01	75
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	29
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	17
Total of all active and inactive participants	2014-01-01	46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	46
Number of participants with account balances	2014-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	77
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	104
Total of all active and inactive participants	2013-01-01	181
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	181
Number of participants with account balances	2013-01-01	143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	45
2012: CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	180
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	229
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	6
Total of all active and inactive participants	2012-01-01	235
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	235
Number of participants with account balances	2012-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN

Measure	Date	Value
2019 : CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$-581,617
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$103,149
Expenses. Total of all expenses incurred	2019-12-31	$137,485
Benefits paid (including direct rollovers)	2019-12-31	$132,327
Total plan assets at end of year	2019-12-31	$0
Total plan assets at beginning of year	2019-12-31	$615,953
Value of fidelity bond covering the plan	2019-12-31	$250,000
Total contributions received or receivable from participants	2019-12-31	$68,625
Contributions received from other sources (not participants or employers)	2019-12-31	$19,092
Other income received	2019-12-31	$15,432
Net income (gross income less expenses)	2019-12-31	$-34,336
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$615,953
Assets. Value of participant loans	2019-12-31	$0
Total contributions received or receivable from employer(s)	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$5,158
2018 : CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2018 401k financial data
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$3,360
Total income from all sources	2018-12-31	$511,359
Expenses. Total of all expenses incurred	2018-12-31	$487,997
Benefits paid (including direct rollovers)	2018-12-31	$473,012
Total plan assets at end of year	2018-12-31	$615,953
Total plan assets at beginning of year	2018-12-31	$595,951
Value of fidelity bond covering the plan	2018-12-31	$250,000
Total contributions received or receivable from participants	2018-12-31	$150,686
Contributions received from other sources (not participants or employers)	2018-12-31	$356,723
Other income received	2018-12-31	$-31,402
Net income (gross income less expenses)	2018-12-31	$23,362
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$615,953
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$592,591
Assets. Value of participant loans	2018-12-31	$1,421
Total contributions received or receivable from employer(s)	2018-12-31	$35,352
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$14,985
2017 : CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2017 401k financial data
Total plan liabilities at end of year	2017-12-31	$3,360
Total plan liabilities at beginning of year	2017-12-31	$880
Total income from all sources	2017-12-31	$130,297
Expenses. Total of all expenses incurred	2017-12-31	$152,012
Benefits paid (including direct rollovers)	2017-12-31	$139,894
Total plan assets at end of year	2017-12-31	$595,951
Total plan assets at beginning of year	2017-12-31	$615,186
Value of fidelity bond covering the plan	2017-12-31	$250,000
Total contributions received or receivable from participants	2017-12-31	$38,617
Contributions received from other sources (not participants or employers)	2017-12-31	$1,188
Other income received	2017-12-31	$80,838
Net income (gross income less expenses)	2017-12-31	$-21,715
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$592,591
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$614,306
Assets. Value of participant loans	2017-12-31	$1,363
Total contributions received or receivable from employer(s)	2017-12-31	$9,654
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$12,118
2016 : CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-12-31	$880
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$75,333
Expenses. Total of all expenses incurred	2016-12-31	$129,870
Benefits paid (including direct rollovers)	2016-12-31	$101,628
Total plan assets at end of year	2016-12-31	$615,186
Total plan assets at beginning of year	2016-12-31	$668,843
Total contributions received or receivable from participants	2016-12-31	$2,520
Contributions received from other sources (not participants or employers)	2016-12-31	$2,439
Other income received	2016-12-31	$52,890
Net income (gross income less expenses)	2016-12-31	$-54,537
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$614,306
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$668,843
Assets. Value of participant loans	2016-12-31	$1,307
Total contributions received or receivable from employer(s)	2016-12-31	$17,484
Value of certain deemed distributions of participant loans	2016-12-31	$4,642
Value of corrective distributions	2016-12-31	$11,819
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$11,781
2015 : CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$-18,797
Expenses. Total of all expenses incurred	2015-12-31	$370,650
Benefits paid (including direct rollovers)	2015-12-31	$317,386
Total plan assets at end of year	2015-12-31	$668,843
Total plan assets at beginning of year	2015-12-31	$1,058,290
Total contributions received or receivable from participants	2015-12-31	$0
Other income received	2015-12-31	$-18,797
Net income (gross income less expenses)	2015-12-31	$-389,447
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$668,843
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,058,290
Assets. Value of participant loans	2015-12-31	$3,562
Total contributions received or receivable from employer(s)	2015-12-31	$0
Value of certain deemed distributions of participant loans	2015-12-31	$39,395
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$13,869
2014 : CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$117,964
Total of all expenses incurred	2014-12-31	$1,372,409
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$1,347,771
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$38,922
Value of total assets at end of year	2014-12-31	$1,059,145
Value of total assets at beginning of year	2014-12-31	$2,313,590
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$24,638
Total interest from all sources	2014-12-31	$3,299
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	No
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$38,922
Participant contributions at end of year	2014-12-31	$41,385
Participant contributions at beginning of year	2014-12-31	$135,666
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Total non interest bearing cash at end of year	2014-12-31	$17,592
Total non interest bearing cash at beginning of year	2014-12-31	$7,553
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-1,254,445
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,059,145
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,313,590
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Investment advisory and management fees	2014-12-31	$21,513
Value of interest in pooled separate accounts at end of year	2014-12-31	$1,000,168
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$2,170,371
Interest on participant loans	2014-12-31	$3,299
Income. Interest from loans (other than to participants)	2014-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$0
Net investment gain/loss from pooled separate accounts	2014-12-31	$75,743
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$0
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$1,347,771
Contract administrator fees	2014-12-31	$3,125
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	KEVIN LAWRENCE
Accountancy firm EIN	2014-12-31	412100638
2013 : CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$787,407
Total of all expenses incurred	2013-12-31	$214,250
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$186,440
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$560,295
Value of total assets at end of year	2013-12-31	$2,313,590
Value of total assets at beginning of year	2013-12-31	$1,740,433
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$27,810
Total interest from all sources	2013-12-31	$3,550
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$554,077
Participant contributions at end of year	2013-12-31	$135,666
Participant contributions at beginning of year	2013-12-31	$68,354
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$17,344
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$6,218
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$0
Total non interest bearing cash at end of year	2013-12-31	$7,553
Total non interest bearing cash at beginning of year	2013-12-31	$5,252
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$573,157
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,313,590
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,740,433
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Investment advisory and management fees	2013-12-31	$25,610
Value of interest in pooled separate accounts at end of year	2013-12-31	$2,170,371
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$1,463,799
Interest on participant loans	2013-12-31	$3,550
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$0
Net investment gain/loss from pooled separate accounts	2013-12-31	$223,562
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$0
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$185,684
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$186,440
Contract administrator fees	2013-12-31	$2,200
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	KEVIN LAWRENCE
Accountancy firm EIN	2013-12-31	412100638
2012 : CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$1,575
Total income from all sources (including contributions)	2012-12-31	$782,391
Total of all expenses incurred	2012-12-31	$28,473
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$7,022
Expenses. Certain deemed distributions of participant loans	2012-12-31	$2,279
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$659,450
Value of total assets at end of year	2012-12-31	$1,740,433
Value of total assets at beginning of year	2012-12-31	$988,090
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$19,172
Total interest from all sources	2012-12-31	$1,702
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$385,141
Participant contributions at end of year	2012-12-31	$68,354
Participant contributions at beginning of year	2012-12-31	$27,227
Participant contributions at end of year	2012-12-31	$17,344
Participant contributions at beginning of year	2012-12-31	$22,502
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$88,624
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$1,575
Total non interest bearing cash at end of year	2012-12-31	$5,252
Total non interest bearing cash at beginning of year	2012-12-31	$1,340
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$753,918
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,740,433
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$986,515
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Investment advisory and management fees	2012-12-31	$18,122
Value of interest in pooled separate accounts at end of year	2012-12-31	$1,463,799
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$828,118
Interest on participant loans	2012-12-31	$1,702
Interest earned on other investments	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$0
Net investment gain/loss from pooled separate accounts	2012-12-31	$121,239
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$185,685
Employer contributions (assets) at end of year	2012-12-31	$185,684
Employer contributions (assets) at beginning of year	2012-12-31	$108,903
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$7,022
Contract administrator fees	2012-12-31	$1,050
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	KEVIN LAWRENCE
Accountancy firm EIN	2012-12-31	412100638

Form 5500 Responses for CHARTER HOSPICE, INC. EMPLOYEE RETIREMENT PLAN

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

Insurance Providers Used on plan

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

Policy contract number

68583

Policy instance

Insurance contract or identification number	68583
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $180
Are there contracts with allocated funds for group deferred annuity?	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	180
Additional information about fees paid to insurance broker	TPA FEES AND COMPENSATION
Insurance broker organization code?	5

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

Policy contract number

68583

Policy instance

Insurance contract or identification number	68583
Number of Individuals Covered	176
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,329
Are there contracts with allocated funds for group deferred annuity?	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	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	TPA FEES AND COMPENSATION

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

Policy contract number

68583

Policy instance

Insurance contract or identification number	68583
Number of Individuals Covered	228
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,394
Total amount of fees paid to insurance company	USD $781
Are there contracts with allocated funds for group deferred annuity?	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 $5,394
Insurance broker organization code?	3
Amount paid for insurance broker fees	781
Additional information about fees paid to insurance broker	TPA FEES AND COMPENSATION
Insurance broker name	WAKE FINANCIAL GROUP INC

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

Policy contract number

68583

Policy instance

Insurance contract or identification number	68583
Number of Individuals Covered	75
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,994
Total amount of fees paid to insurance company	USD $1,210
Are there contracts with allocated funds for group deferred annuity?	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 $7,994
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	1210
Insurance broker name	WAKE FINANCIAL GROUP INC

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

Policy contract number

68583

Policy instance

Insurance contract or identification number	68583
Number of Individuals Covered	28
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $17,549
Total amount of fees paid to insurance company	USD $3,462
Are there contracts with allocated funds for group deferred annuity?	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 $17,549
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	3462
Insurance broker name	WAKE FINANCIAL GROUP INC

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

Policy contract number

68583

Policy instance

Insurance contract or identification number	68583
Number of Individuals Covered	143
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $19,666
Total amount of fees paid to insurance company	USD $3,120
Are there contracts with allocated funds for group deferred annuity?	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 $19,666
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	WAKE FINANCIAL GROUP INC

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

Policy contract number

68583

Policy instance

Insurance contract or identification number	68583
Number of Individuals Covered	94
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $11,755
Total amount of fees paid to insurance company	USD $1,585
Are there contracts with allocated funds for group deferred annuity?	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 $11,755
Insurance broker organization code?	3
Amount paid for insurance broker fees	1585
Additional information about fees paid to insurance broker	TPA FEES AND COMPENSATION
Insurance broker name	WAKE FINANCIAL GROUP INC

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Company Name:	CHARTER HOSPICE, INC.
Employer identification number (EIN):	870742297
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities