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| Plan Name | PREFERRED HOME CARE WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ASSISTCARE HOME HEALTH SERVICES LLC |
| Employer identification number (EIN): | 134335658 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2015-02-01 | SHAYA MANNE | |||
| 501 | 2014-02-01 | SHAYA MANNE |
| 2015: PREFERRED HOME CARE WELFARE PLAN 2015 form 5500 responses | ||
|---|---|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | This submission is the final filing | Yes |
| 2015-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: PREFERRED HOME CARE WELFARE PLAN 2014 form 5500 responses | ||
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | First time form 5500 has been submitted | Yes |
| 2014-02-01 | Submission has been amended | No |
| 2014-02-01 | This submission is the final filing | No |
| 2014-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-02-01 | Plan is a collectively bargained plan | No |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| COMPANION LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62243 ) | |
| Policy contract number | GLCL 0ASAZ |
| Policy instance | 1 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) | |
| Policy contract number | MP 0ASAZ |
| Policy instance | 2 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) | |
| Policy contract number | GMG 0ASAZ |
| Policy instance | 3 |
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