401k Plan data: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN plan

GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 401k Plan overview

Plan Name	GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN
Plan identification number	503

GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

GENTIVA HEALTH SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: GENTIVA HEALTH SERVICES, INC.

Employer identification number (EIN): 364335801

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2017-04-12 KIMBERLY RUSSELL KIMBERLY RUSSELL 2018-08-21
503 2016-04-12 KIMBERLY RUSSELL KIMBERLY RUSSELL 2018-08-21
503 2015-04-12 KIMBERLY RUSSELL KIMBERLY RUSSELL 2018-08-21
503 2011-04-12 JOHN H KARR

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2017-04-12	KIMBERLY RUSSELL	KIMBERLY RUSSELL	2018-08-21
503	2016-04-12	KIMBERLY RUSSELL	KIMBERLY RUSSELL	2018-08-21
503	2015-04-12	KIMBERLY RUSSELL	KIMBERLY RUSSELL	2018-08-21
503	2011-04-12	JOHN H KARR

Plan Statistics for GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN

401k plan membership statisitcs for GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN

Measure Date Value
2017: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-04-12 23,117
Total number of active participants reported on line 7a of the Form 5500 2017-04-12 22,042
Total of all active and inactive participants 2017-04-12 22,042
2016: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-04-12 31,787
Total number of active participants reported on line 7a of the Form 5500 2016-04-12 23,117
Total of all active and inactive participants 2016-04-12 23,117
2015: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-04-12 32,640
Total number of active participants reported on line 7a of the Form 5500 2015-04-12 31,787
Total of all active and inactive participants 2015-04-12 31,787
2011: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-04-12 2,243
Total number of active participants reported on line 7a of the Form 5500 2011-04-12 2,186
Number of retired or separated participants receiving benefits 2011-04-12 36
Number of other retired or separated participants entitled to future benefits 2011-04-12 0
Total of all active and inactive participants 2011-04-12 2,222

Measure	Date	Value
2017: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-04-12	23,117
Total number of active participants reported on line 7a of the Form 5500	2017-04-12	22,042
Total of all active and inactive participants	2017-04-12	22,042
2016: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-04-12	31,787
Total number of active participants reported on line 7a of the Form 5500	2016-04-12	23,117
Total of all active and inactive participants	2016-04-12	23,117
2015: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-04-12	32,640
Total number of active participants reported on line 7a of the Form 5500	2015-04-12	31,787
Total of all active and inactive participants	2015-04-12	31,787
2011: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-04-12	2,243
Total number of active participants reported on line 7a of the Form 5500	2011-04-12	2,186
Number of retired or separated participants receiving benefits	2011-04-12	36
Number of other retired or separated participants entitled to future benefits	2011-04-12	0
Total of all active and inactive participants	2011-04-12	2,222

Form 5500 Responses for GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN

2017: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2017 form 5500 responses
2017-04-12	Type of plan entity	Single employer plan
2017-04-12	Submission has been amended	Yes
2017-04-12	This submission is the final filing	No
2017-04-12	This return/report is a short plan year return/report (less than 12 months)	No
2017-04-12	Plan is a collectively bargained plan	No
2017-04-12	Plan funding arrangement – General assets of the sponsor	Yes
2017-04-12	Plan benefit arrangement – General assets of the sponsor	Yes
2016: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2016 form 5500 responses
2016-04-12	Type of plan entity	Single employer plan
2016-04-12	Submission has been amended	Yes
2016-04-12	This submission is the final filing	No
2016-04-12	This return/report is a short plan year return/report (less than 12 months)	No
2016-04-12	Plan is a collectively bargained plan	No
2016-04-12	Plan funding arrangement – General assets of the sponsor	Yes
2016-04-12	Plan benefit arrangement – General assets of the sponsor	Yes
2015: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2015 form 5500 responses
2015-04-12	Type of plan entity	Single employer plan
2015-04-12	Submission has been amended	Yes
2015-04-12	This submission is the final filing	No
2015-04-12	This return/report is a short plan year return/report (less than 12 months)	No
2015-04-12	Plan is a collectively bargained plan	No
2015-04-12	Plan funding arrangement – General assets of the sponsor	Yes
2015-04-12	Plan benefit arrangement – General assets of the sponsor	Yes
2011: GENTIVA HEALTH SERVICES, INC. OCCUPATIONAL INJURY BENEFIT PLAN 2011 form 5500 responses
2011-04-12	Type of plan entity	Single employer plan
2011-04-12	Submission has been amended	No
2011-04-12	This submission is the final filing	No
2011-04-12	This return/report is a short plan year return/report (less than 12 months)	No
2011-04-12	Plan is a collectively bargained plan	No
2011-04-12	Plan funding arrangement – General assets of the sponsor	Yes
2011-04-12	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	GENTIVA HEALTH SERVICES, INC.
Employer identification number (EIN):	364335801
NAIC Classification:	621610
NAIC Description:	Home Health Care Services