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OLD COLONY HOSPICE, INC. 403(B) PLAN 401k Plan overview

Plan NameOLD COLONY HOSPICE, INC. 403(B) PLAN
Plan identification number 001

OLD COLONY HOSPICE, INC. 403(B) 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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • 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

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

Company Name:OLD COLONY HOSPICE, INC.
Employer identification number (EIN):042793637
NAIC Classification:621610
NAIC Description:Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OLD COLONY HOSPICE, INC. 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01JOHN ZALIS2023-10-05
0012021-01-01JOHN ZALIS2022-10-11
0012020-01-01
0012019-01-01MELISSA CLARK2020-05-26 MELISSA CLARK2020-05-26
0012018-01-01MELISSA CLARK2019-04-11 MELISSA CLARK2019-04-11
0012017-01-01MELISSA CLARK2018-07-16 MELISSA CLARK2018-07-16
0012016-01-01MELISSA CLARK2017-05-22 MELISSA CLARK2017-05-22
0012015-01-01MELISSA CLARK2016-06-08 MELISSA CLARK2016-06-08
0012014-02-01MELISSA CLARK2015-04-21 MELISSA CLARK2015-04-21

Plan Statistics for OLD COLONY HOSPICE, INC. 403(B) PLAN

401k plan membership statisitcs for OLD COLONY HOSPICE, INC. 403(B) PLAN

Measure Date Value
2022: OLD COLONY HOSPICE, INC. 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01144
Total number of active participants reported on line 7a of the Form 55002022-01-01149
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0119
Total of all active and inactive participants2022-01-01168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01168
Number of participants with account balances2022-01-0197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-011
2021: OLD COLONY HOSPICE, INC. 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01129
Total number of active participants reported on line 7a of the Form 55002021-01-01125
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0119
Total of all active and inactive participants2021-01-01144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01144
Number of participants with account balances2021-01-0176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-011

Financial Data on OLD COLONY HOSPICE, INC. 403(B) PLAN

Measure Date Value
2022 : OLD COLONY HOSPICE, INC. 403(B) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$236,537
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$36,557
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$12,060
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$558,538
Value of total assets at end of year2022-12-31$2,392,231
Value of total assets at beginning of year2022-12-31$2,192,251
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$24,497
Total interest from all sources2022-12-31$1,096
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$61,589
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$61,589
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$1,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$349,079
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$209,459
Assets. Loans (other than to participants) at end of year2022-12-31$124,085
Assets. Loans (other than to participants) at beginning of year2022-12-31$120,840
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$199,980
Value of net assets at end of year (total assets less liabilities)2022-12-31$2,392,231
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$2,192,251
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$2,037,206
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$1,830,437
Interest on participant loans2022-12-31$4,248
Interest earned on other investments2022-12-31$-3,152
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$230,940
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$240,974
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-384,686
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$12,060
Contract administrator fees2022-12-31$24,497
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31BERRY, DUNN, MCNEIL & PARKER, LLC
Accountancy firm EIN2022-12-31010523282
2021 : OLD COLONY HOSPICE, INC. 403(B) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$640,642
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$217,097
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$197,246
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$423,027
Value of total assets at end of year2021-12-31$2,192,251
Value of total assets at beginning of year2021-12-31$1,768,706
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$19,851
Total interest from all sources2021-12-31$5,349
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$80,128
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$80,128
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,000,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$279,197
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$143,830
Assets. Loans (other than to participants) at end of year2021-12-31$120,840
Assets. Loans (other than to participants) at beginning of year2021-12-31$41,250
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$423,545
Value of net assets at end of year (total assets less liabilities)2021-12-31$2,192,251
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,768,706
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$1,830,437
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$1,577,352
Interest on participant loans2021-12-31$3,341
Interest earned on other investments2021-12-31$2,008
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$240,974
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$150,104
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$132,138
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$197,246
Contract administrator fees2021-12-31$19,851
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31BERRY, DUNN, MCNEIL & PARKER, LLC
Accountancy firm EIN2021-12-31010523282

Form 5500 Responses for OLD COLONY HOSPICE, INC. 403(B) PLAN

2022: OLD COLONY HOSPICE, INC. 403(B) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: OLD COLONY HOSPICE, INC. 403(B) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number814319
Policy instance 1
Insurance contract or identification number814319
Number of Individuals Covered168
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number814319
Policy instance 1
Insurance contract or identification number814319
Number of Individuals Covered144
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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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