401k Plan data: SANS BOIS HEALTH SERVICES, INC. plan

SANS BOIS HEALTH SERVICES, INC. 401k Plan overview

Plan Name	SANS BOIS HEALTH SERVICES, INC.
Plan identification number	001

SANS BOIS HEALTH SERVICES, INC. Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
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.

401k Sponsoring company profile

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

Company Name: SANS BOIS HEALTH SERVICES, INC.

Employer identification number (EIN): 731599299

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SANS BOIS HEALTH SERVICES, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 STEPHANIE BRYANT 2014-07-24
001 2013-01-01 STEPHANIE BRYANT 2014-07-16
001 2012-01-01 STEPHANIE BRYANT
001 2009-01-01 TALLY BUTCHER TALLY BUTCHER 2010-10-06
001 2009-01-01 PAUL DAGOSTINO PAUL DAGOSTINO 2010-10-13
001 2009-01-01 PAUL DAGOSTINO PAUL DAGOSTINO 2010-10-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2014-01-01	STEPHANIE BRYANT	2014-07-24
001	2013-01-01	STEPHANIE BRYANT	2014-07-16
001	2012-01-01	STEPHANIE BRYANT
001	2009-01-01	TALLY BUTCHER		TALLY BUTCHER	2010-10-06
001	2009-01-01	PAUL DAGOSTINO		PAUL DAGOSTINO	2010-10-13
001	2009-01-01	PAUL DAGOSTINO		PAUL DAGOSTINO	2010-10-01

Plan Statistics for SANS BOIS HEALTH SERVICES, INC.

401k plan membership statisitcs for SANS BOIS HEALTH SERVICES, INC.

Measure Date Value
2012: SANS BOIS HEALTH SERVICES, INC. 2012 401k membership
Total participants, beginning-of-year 2012-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 58
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 10
Total of all active and inactive participants 2012-01-01 68
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 68
Number of participants with account balances 2012-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2009: SANS BOIS HEALTH SERVICES, INC. 2009 401k membership
Total participants, beginning-of-year 2009-01-01 24
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 27
Total of all active and inactive participants 2009-01-01 27
Total participants 2009-01-01 27

Measure	Date	Value
2012: SANS BOIS HEALTH SERVICES, INC. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	58
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	10
Total of all active and inactive participants	2012-01-01	68
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	68
Number of participants with account balances	2012-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2009: SANS BOIS HEALTH SERVICES, INC. 2009 401k membership
Total participants, beginning-of-year	2009-01-01	24
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	27
Total of all active and inactive participants	2009-01-01	27
Total participants	2009-01-01	27

Financial Data on SANS BOIS HEALTH SERVICES, INC.

Measure	Date	Value
2012 : SANS BOIS HEALTH SERVICES, INC. 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
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	$0
Total income from all sources (including contributions)	2012-12-31	$261,179
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$154,476
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$154,462
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$170,348
Value of total assets at end of year	2012-12-31	$1,185,176
Value of total assets at beginning of year	2012-12-31	$1,078,473
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$14
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
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	$125,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$104,847
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$6,010
Administrative expenses (other) incurred	2012-12-31	$14
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	$106,703
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,185,176
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,078,473
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
Value of interest in pooled separate accounts at end of year	2012-12-31	$1,185,176
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$1,078,473
Net investment gain/loss from pooled separate accounts	2012-12-31	$90,831
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	$59,491
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$154,462
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	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	CRAIG CARTER & ASSOCIATES
Accountancy firm EIN	2012-12-31	731522302
2010 : SANS BOIS HEALTH SERVICES, INC. 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$336,726
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$20,688
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$20,688
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$209,107
Value of total assets at end of year	2010-12-31	$955,067
Value of total assets at beginning of year	2010-12-31	$639,029
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Total income from all sources	2010-12-31	$419,174
Expenses. Total of all expenses incurred	2010-12-31	$134,857
Total plan assets at end of year	2010-12-31	$668,619
Total plan assets at beginning of year	2010-12-31	$384,302
Expenses. Other expenses not covered elsewhere	2010-12-31	$134,857
Other income received	2010-12-31	$95,518
Net income (gross income less expenses)	2010-12-31	$284,317
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$668,619
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$384,302
Total contributions received or receivable from employer(s)	2010-12-31	$323,656
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$50,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$128,447
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$316,038
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$955,067
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$639,029
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$955,067
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$639,029
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$0
Net investment gain/loss from pooled separate accounts	2010-12-31	$127,619
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$80,660
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$20,688
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	CRAIG CARTER & ASSOCIATES
Accountancy firm EIN	2010-12-31	731522302

Form 5500 Responses for SANS BOIS HEALTH SERVICES, INC.

2012: SANS BOIS HEALTH SERVICES, INC. 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
2009: SANS BOIS HEALTH SERVICES, INC. 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2009-01-01	Plan benefit arrangement – Section 412(e)(3) insurance Contracts	Yes

Insurance Providers Used on plan

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

GA45038

Policy instance

Insurance contract or identification number	GA45038
Number of Individuals Covered	44
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )

Policy contract number

GA45038

Policy instance

Insurance contract or identification number	GA45038
Number of Individuals Covered	57
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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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Company Name:	SANS BOIS HEALTH SERVICES, INC.
Employer identification number (EIN):	731599299
NAIC Classification:	621610
NAIC Description:	Home Health Care Services