401k Plan data: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN plan

GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN
Plan identification number	501

GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

GRACE HEART OF AMERICA HOSPICE, LLC has sponsored the creation of one or more 401k plans.

Company Name: GRACE HEART OF AMERICA HOSPICE, LLC

Employer identification number (EIN): 200112013

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01 DIANE TRAICOFF
501 2015-01-01 DIANE TRAICOFF
501 2014-12-01 DIANE TRAICOFF
501 2013-12-01 DIANE TRAICOFF
501 2012-12-01 DIANE TRAICOFF
501 2011-12-01 DIANE TRAICOFF
501 2009-12-01 DIANE TRAICOFF

Plan id#	Filing Submission Date	Name of Administrator
501	2016-01-01	DIANE TRAICOFF
501	2015-01-01	DIANE TRAICOFF
501	2014-12-01	DIANE TRAICOFF
501	2013-12-01	DIANE TRAICOFF
501	2012-12-01	DIANE TRAICOFF
501	2011-12-01	DIANE TRAICOFF
501	2009-12-01	DIANE TRAICOFF

Plan Statistics for GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN

Measure Date Value
2016: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 147
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 133
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 0
Total of all active and inactive participants 2016-01-01 133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 133
2015: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 147
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 0
Total of all active and inactive participants 2015-01-01 147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 147
2014: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-12-01 134
Total number of active participants reported on line 7a of the Form 5500 2014-12-01 141
Number of retired or separated participants receiving benefits 2014-12-01 0
Number of other retired or separated participants entitled to future benefits 2014-12-01 0
Total of all active and inactive participants 2014-12-01 141
Total participants 2014-12-01 141
2013: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-12-01 134
Total number of active participants reported on line 7a of the Form 5500 2013-12-01 141
Number of retired or separated participants receiving benefits 2013-12-01 0
Number of other retired or separated participants entitled to future benefits 2013-12-01 0
Total of all active and inactive participants 2013-12-01 141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-12-01 0
Total participants 2013-12-01 141
2012: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-12-01 134
Total number of active participants reported on line 7a of the Form 5500 2012-12-01 134
Number of retired or separated participants receiving benefits 2012-12-01 0
Number of other retired or separated participants entitled to future benefits 2012-12-01 0
Total of all active and inactive participants 2012-12-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-12-01 0
Total participants 2012-12-01 134
2011: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-12-01 130
Total number of active participants reported on line 7a of the Form 5500 2011-12-01 134
Number of retired or separated participants receiving benefits 2011-12-01 0
Number of other retired or separated participants entitled to future benefits 2011-12-01 0
Total of all active and inactive participants 2011-12-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-12-01 0
Total participants 2011-12-01 134
2009: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-12-01 100
Total number of active participants reported on line 7a of the Form 5500 2009-12-01 121
Number of retired or separated participants receiving benefits 2009-12-01 0
Number of other retired or separated participants entitled to future benefits 2009-12-01 0
Total of all active and inactive participants 2009-12-01 121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-12-01 0
Total participants 2009-12-01 121

Measure	Date	Value
2016: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	147
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	133
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	0
Total of all active and inactive participants	2016-01-01	133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	133
2015: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	147
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	0
Total of all active and inactive participants	2015-01-01	147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	147
2014: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-12-01	134
Total number of active participants reported on line 7a of the Form 5500	2014-12-01	141
Number of retired or separated participants receiving benefits	2014-12-01	0
Number of other retired or separated participants entitled to future benefits	2014-12-01	0
Total of all active and inactive participants	2014-12-01	141
Total participants	2014-12-01	141
2013: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-12-01	134
Total number of active participants reported on line 7a of the Form 5500	2013-12-01	141
Number of retired or separated participants receiving benefits	2013-12-01	0
Number of other retired or separated participants entitled to future benefits	2013-12-01	0
Total of all active and inactive participants	2013-12-01	141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-12-01	0
Total participants	2013-12-01	141
2012: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-12-01	134
Total number of active participants reported on line 7a of the Form 5500	2012-12-01	134
Number of retired or separated participants receiving benefits	2012-12-01	0
Number of other retired or separated participants entitled to future benefits	2012-12-01	0
Total of all active and inactive participants	2012-12-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-12-01	0
Total participants	2012-12-01	134
2011: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-12-01	130
Total number of active participants reported on line 7a of the Form 5500	2011-12-01	134
Number of retired or separated participants receiving benefits	2011-12-01	0
Number of other retired or separated participants entitled to future benefits	2011-12-01	0
Total of all active and inactive participants	2011-12-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-12-01	0
Total participants	2011-12-01	134
2009: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-12-01	100
Total number of active participants reported on line 7a of the Form 5500	2009-12-01	121
Number of retired or separated participants receiving benefits	2009-12-01	0
Number of other retired or separated participants entitled to future benefits	2009-12-01	0
Total of all active and inactive participants	2009-12-01	121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-12-01	0
Total participants	2009-12-01	121

Form 5500 Responses for GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN

2016: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS 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 benefit arrangement – Insurance	Yes
2015: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS 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 benefit arrangement – Insurance	Yes
2014: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2014 form 5500 responses
2014-12-01	Type of plan entity	Single employer plan
2014-12-01	Submission has been amended	No
2014-12-01	This submission is the final filing	No
2014-12-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-12-01	Plan is a collectively bargained plan	No
2014-12-01	Plan funding arrangement – Insurance	Yes
2014-12-01	Plan benefit arrangement – Insurance	Yes
2013: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2013 form 5500 responses
2013-12-01	Type of plan entity	Single employer plan
2013-12-01	Submission has been amended	No
2013-12-01	This submission is the final filing	No
2013-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-12-01	Plan is a collectively bargained plan	No
2013-12-01	Plan funding arrangement – Insurance	Yes
2013-12-01	Plan benefit arrangement – Insurance	Yes
2012: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2012 form 5500 responses
2012-12-01	Type of plan entity	Single employer plan
2012-12-01	Submission has been amended	No
2012-12-01	This submission is the final filing	No
2012-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-12-01	Plan is a collectively bargained plan	No
2012-12-01	Plan funding arrangement – Insurance	Yes
2012-12-01	Plan benefit arrangement – Insurance	Yes
2011: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2011 form 5500 responses
2011-12-01	Type of plan entity	Single employer plan
2011-12-01	Submission has been amended	No
2011-12-01	This submission is the final filing	No
2011-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-12-01	Plan is a collectively bargained plan	No
2011-12-01	Plan funding arrangement – Insurance	Yes
2011-12-01	Plan benefit arrangement – Insurance	Yes
2009: GRACE HEART OF AMERICA HOSPICE, LLC EMPLOYEE BENEFITS PLAN 2009 form 5500 responses
2009-12-01	Type of plan entity	Single employer plan
2009-12-01	First time form 5500 has been submitted	Yes
2009-12-01	Submission has been amended	No
2009-12-01	This submission is the final filing	No
2009-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-12-01	Plan is a collectively bargained plan	No
2009-12-01	Plan funding arrangement – Insurance	Yes
2009-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )
Policy contract number	37141000
Policy instance	3
DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )
Policy contract number	24442
Policy instance	2
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	97501,02
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	97501,02
Policy instance	1
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	0847659
Policy instance	2
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	97501,02
Policy instance	1
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	0847659
Policy instance	2
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number	847659
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10097501/02
Policy instance	3
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number	5051631001/02
Policy instance	2
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10097501,2
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10097501,02
Policy instance	1

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Company Name:	GRACE HEART OF AMERICA HOSPICE, LLC
Employer identification number (EIN):	200112013
NAIC Classification:	621610
NAIC Description:	Home Health Care Services