401k Plan data: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN plan

ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 401k Plan overview

Plan Name	ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN
Plan identification number	001

ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN Benefits

401k Plan Type

Defined 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 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.
Plan covering Self-Employed individuals.
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

ALPINE HOME MEDICAL EQUIPMENT has sponsored the creation of one or more 401k plans.

Company Name: ALPINE HOME MEDICAL EQUIPMENT

Employer identification number (EIN): 870563433

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01
001 2019-06-01
001 2016-01-01 SCOTT SCRIBER
001 2015-01-01 SCOTT SCRIBER
001 2015-01-01 SCOTT SCRIBER
001 2014-01-01 SCOTT SCRIBER
001 2014-01-01 SCOTT SCRIBER
001 2013-01-01 SCOTT SCRIBER 2014-07-28
001 2012-01-01 SCOTT SCRIBER 2013-07-22
001 2011-01-01 SCOTT SCRIBER 2012-05-31
001 2010-01-01 SCOTT SCRIBER 2011-07-06

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2020-01-01
001	2019-06-01
001	2016-01-01	SCOTT SCRIBER
001	2015-01-01	SCOTT SCRIBER
001	2015-01-01	SCOTT SCRIBER
001	2014-01-01	SCOTT SCRIBER
001	2014-01-01	SCOTT SCRIBER
001	2013-01-01	SCOTT SCRIBER	2014-07-28
001	2012-01-01	SCOTT SCRIBER	2013-07-22
001	2011-01-01	SCOTT SCRIBER	2012-05-31
001	2010-01-01	SCOTT SCRIBER	2011-07-06

Plan Statistics for ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN

401k plan membership statisitcs for ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN

Measure Date Value
2020: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 154
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 33
Total of all active and inactive participants 2020-01-01 187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 187
Number of participants with account balances 2020-01-01 123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 4
2019: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-06-01 133
Total number of active participants reported on line 7a of the Form 5500 2019-06-01 137
Number of retired or separated participants receiving benefits 2019-06-01 1
Number of other retired or separated participants entitled to future benefits 2019-06-01 17
Total of all active and inactive participants 2019-06-01 155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-06-01 0
Total participants 2019-06-01 155
Number of participants with account balances 2019-06-01 92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-06-01 0
2016: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 140
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 16
Total of all active and inactive participants 2015-01-01 156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 156
Number of participants with account balances 2015-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 3
2014: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 137
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 13
Total of all active and inactive participants 2014-01-01 150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 150
Number of participants with account balances 2014-01-01 72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 3

Measure	Date	Value
2020: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	154
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	33
Total of all active and inactive participants	2020-01-01	187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	187
Number of participants with account balances	2020-01-01	123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	4
2019: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-06-01	133
Total number of active participants reported on line 7a of the Form 5500	2019-06-01	137
Number of retired or separated participants receiving benefits	2019-06-01	1
Number of other retired or separated participants entitled to future benefits	2019-06-01	17
Total of all active and inactive participants	2019-06-01	155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-06-01	0
Total participants	2019-06-01	155
Number of participants with account balances	2019-06-01	92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-06-01	0
2016: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	140
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	16
Total of all active and inactive participants	2015-01-01	156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	156
Number of participants with account balances	2015-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	3
2014: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	137
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	13
Total of all active and inactive participants	2014-01-01	150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	150
Number of participants with account balances	2014-01-01	72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	3

Financial Data on ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN

Measure	Date	Value
2020 : ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$1,214,609
Total of all expenses incurred	2020-12-31	$528,231
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$480,812
Value of total corrective distributions	2020-12-31	$3,134
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$550,736
Value of total assets at end of year	2020-12-31	$5,034,213
Value of total assets at beginning of year	2020-12-31	$4,347,835
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$44,285
Total interest from all sources	2020-12-31	$6,831
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$108,605
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$108,605
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$449,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$360,096
Participant contributions at end of year	2020-12-31	$97,511
Participant contributions at beginning of year	2020-12-31	$124,036
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$87
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$347
Administrative expenses (other) incurred	2020-12-31	$18,716
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$686,378
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$5,034,213
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$4,347,835
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$25,569
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$4,915,080
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$4,221,252
Interest on participant loans	2020-12-31	$6,831
Value of interest in common/collective trusts at end of year	2020-12-31	$19,289
Value of interest in common/collective trusts at beginning of year	2020-12-31	$2,200
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$2,246
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$548,327
Net investment gain/loss from pooled separate accounts	2020-12-31	$110
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$190,640
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$480,812
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	2020-12-31	No
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	MUMFORD GROUP
Accountancy firm EIN	2020-12-31	455314341
2019 : ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2019 401k financial data
Total transfer of assets to this plan	2019-12-31	$3,909,552
Total transfer of assets to this plan	2019-12-31	$3,909,552
Total income from all sources (including contributions)	2019-12-31	$505,328
Total income from all sources (including contributions)	2019-12-31	$505,328
Total of all expenses incurred	2019-12-31	$67,045
Total of all expenses incurred	2019-12-31	$67,045
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$58,401
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$288,665
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$288,665
Value of total assets at end of year	2019-12-31	$4,347,835
Value of total assets at end of year	2019-12-31	$4,347,835
Value of total assets at beginning of year	2019-12-31	$0
Value of total assets at beginning of year	2019-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$8,644
Total interest from all sources	2019-12-31	$3,456
Total interest from all sources	2019-12-31	$3,456
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$17,718
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$17,718
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$17,718
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$17,718
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$184,692
Contributions received from participants	2019-12-31	$184,692
Participant contributions at end of year	2019-12-31	$124,036
Participant contributions at end of year	2019-12-31	$124,036
Participant contributions at beginning of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$9,968
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$9,968
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$347
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$347
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$0
Administrative expenses (other) incurred	2019-12-31	$8,644
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$438,283
Value of net income/loss	2019-12-31	$438,283
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$4,347,835
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$4,347,835
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$4,221,252
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$4,221,252
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$0
Interest on participant loans	2019-12-31	$3,456
Interest on participant loans	2019-12-31	$3,456
Value of interest in common/collective trusts at end of year	2019-12-31	$2,200
Value of interest in common/collective trusts at end of year	2019-12-31	$2,200
Value of interest in common/collective trusts at beginning of year	2019-12-31	$0
Value of interest in common/collective trusts at beginning of year	2019-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$195,464
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$195,464
Net investment gain or loss from common/collective trusts	2019-12-31	$25
Net investment gain or loss from common/collective trusts	2019-12-31	$25
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$94,005
Contributions received in cash from employer	2019-12-31	$94,005
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$58,401
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$58,401
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	2019-12-31	No
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	2019-12-31	No
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MUMFORD GROUP
Accountancy firm EIN	2019-12-31	455314341
Accountancy firm EIN	2019-12-31	455314341
2016 : ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-07-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-07-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-07-31	$0
Total income from all sources (including contributions)	2016-07-31	$-79,023
Total loss/gain on sale of assets	2016-07-31	$0
Total of all expenses incurred	2016-07-31	$2,418,245
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-07-31	$2,416,628
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-07-31	$56,357
Value of total assets at end of year	2016-07-31	$0
Value of total assets at beginning of year	2016-07-31	$2,497,268
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-07-31	$1,617
Total interest from all sources	2016-07-31	$1,203
Total dividends received (eg from common stock, registered investment company shares)	2016-07-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-07-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-07-31	$0
Was this plan covered by a fidelity bond	2016-07-31	Yes
Value of fidelity bond cover	2016-07-31	$250,000
If this is an individual account plan, was there a blackout period	2016-07-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-07-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-07-31	No
Contributions received from participants	2016-07-31	$33,590
Participant contributions at end of year	2016-07-31	$0
Participant contributions at beginning of year	2016-07-31	$95,698
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-07-31	No
Value of net income/loss	2016-07-31	$-2,497,268
Value of net assets at end of year (total assets less liabilities)	2016-07-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-07-31	$2,497,268
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-07-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-07-31	No
Were any leases to which the plan was party in default or uncollectible	2016-07-31	No
Investment advisory and management fees	2016-07-31	$1,267
Value of interest in pooled separate accounts at end of year	2016-07-31	$0
Value of interest in pooled separate accounts at beginning of year	2016-07-31	$2,303,542
Interest on participant loans	2016-07-31	$648
Interest earned on other investments	2016-07-31	$555
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-07-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-07-31	$98,028
Net investment gain/loss from pooled separate accounts	2016-07-31	$-136,583
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-07-31	No
Was there a failure to transmit to the plan any participant contributions	2016-07-31	No
Has the plan failed to provide any benefit when due under the plan	2016-07-31	No
Contributions received in cash from employer	2016-07-31	$22,767
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-07-31	$2,416,628
Contract administrator fees	2016-07-31	$350
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	2016-07-31	No
Did the plan have assets held for investment	2016-07-31	No
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	2016-07-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-07-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-07-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-07-31	Disclaimer
Accountancy firm name	2016-07-31	MUMFORD GROUP
Accountancy firm EIN	2016-07-31	455314341
2015 : ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets	2015-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$0
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Expenses. Interest paid	2015-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$344,113
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$104,003
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$98,118
Expenses. Certain deemed distributions of participant loans	2015-12-31	$0
Value of total corrective distributions	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$372,018
Value of total assets at end of year	2015-12-31	$2,497,268
Value of total assets at beginning of year	2015-12-31	$2,257,158
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$5,885
Total income from rents	2015-12-31	$0
Total interest from all sources	2015-12-31	$4,740
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$0
Assets. Real estate other than employer real property at end of year	2015-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2015-12-31	$0
Administrative expenses professional fees incurred	2015-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2015-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$250,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$217,612
Participant contributions at end of year	2015-12-31	$95,698
Participant contributions at beginning of year	2015-12-31	$107,135
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2015-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$8,513
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$0
Assets. Loans (other than to participants) at end of year	2015-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Other income not declared elsewhere	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$0
Total non interest bearing cash at end of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Income. Non cash contributions	2015-12-31	$0
Value of net income/loss	2015-12-31	$240,110
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,497,268
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,257,158
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Assets. partnership/joint venture interests at end of year	2015-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2015-12-31	$0
Investment advisory and management fees	2015-12-31	$5,035
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$0
Value of interest in pooled separate accounts at end of year	2015-12-31	$2,303,542
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$2,092,266
Interest on participant loans	2015-12-31	$3,815
Income. Interest from loans (other than to participants)	2015-12-31	$0
Interest earned on other investments	2015-12-31	$925
Income. Interest from US Government securities	2015-12-31	$0
Income. Interest from corporate debt instruments	2015-12-31	$0
Value of interest in master investment trust accounts at end of year	2015-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2015-12-31	$0
Value of interest in common/collective trusts at end of year	2015-12-31	$0
Value of interest in common/collective trusts at beginning of year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2015-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$98,028
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$57,757
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$0
Asset value of US Government securities at end of year	2015-12-31	$0
Asset value of US Government securities at beginning of year	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$0
Net investment gain/loss from pooled separate accounts	2015-12-31	$-32,645
Net investment gain or loss from common/collective trusts	2015-12-31	$0
Net gain/loss from 103.12 investment entities	2015-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Assets. Invements in employer securities at end of year	2015-12-31	$0
Assets. Invements in employer securities at beginning of year	2015-12-31	$0
Assets. Value of employer real property at end of year	2015-12-31	$0
Assets. Value of employer real property at beginning of year	2015-12-31	$0
Contributions received in cash from employer	2015-12-31	$145,893
Employer contributions (assets) at end of year	2015-12-31	$0
Employer contributions (assets) at beginning of year	2015-12-31	$0
Income. Dividends from preferred stock	2015-12-31	$0
Income. Dividends from common stock	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$98,118
Asset. Corporate debt instrument preferred debt at end of year	2015-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2015-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2015-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2015-12-31	$0
Contract administrator fees	2015-12-31	$850
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	2015-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2015-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2015-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2015-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2015-12-31	$0
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Aggregate proceeds on sale of assets	2015-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2015-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2015-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2015-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	MUMFORD GROUP
Accountancy firm EIN	2015-12-31	455314341
2014 : ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2014 401k financial data
Unrealized appreciation/depreciation of real estate assets	2014-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$0
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Expenses. Interest paid	2014-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$479,394
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$84,878
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$79,780
Expenses. Certain deemed distributions of participant loans	2014-12-31	$0
Value of total corrective distributions	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$383,182
Value of total assets at end of year	2014-12-31	$2,257,158
Value of total assets at beginning of year	2014-12-31	$1,862,642
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$5,098
Total income from rents	2014-12-31	$0
Total interest from all sources	2014-12-31	$4,558
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Assets. Real estate other than employer real property at end of year	2014-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2014-12-31	$0
Administrative expenses professional fees incurred	2014-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2014-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$200,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$217,608
Participant contributions at end of year	2014-12-31	$107,135
Participant contributions at beginning of year	2014-12-31	$59,255
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2014-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$25,789
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$0
Assets. Loans (other than to participants) at end of year	2014-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$0
Administrative expenses (other) incurred	2014-12-31	$0
Total non interest bearing cash at end of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Income. Non cash contributions	2014-12-31	$0
Value of net income/loss	2014-12-31	$394,516
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,257,158
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,862,642
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Assets. partnership/joint venture interests at end of year	2014-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2014-12-31	$0
Investment advisory and management fees	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$0
Value of interest in pooled separate accounts at end of year	2014-12-31	$2,092,266
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$1,758,583
Interest on participant loans	2014-12-31	$3,947
Income. Interest from loans (other than to participants)	2014-12-31	$0
Interest earned on other investments	2014-12-31	$611
Income. Interest from US Government securities	2014-12-31	$0
Income. Interest from corporate debt instruments	2014-12-31	$0
Value of interest in master investment trust accounts at end of year	2014-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2014-12-31	$0
Value of interest in common/collective trusts at end of year	2014-12-31	$0
Value of interest in common/collective trusts at beginning of year	2014-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2014-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2014-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$57,757
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$44,804
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$0
Asset value of US Government securities at end of year	2014-12-31	$0
Asset value of US Government securities at beginning of year	2014-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$0
Net investment gain/loss from pooled separate accounts	2014-12-31	$91,654
Net investment gain or loss from common/collective trusts	2014-12-31	$0
Net gain/loss from 103.12 investment entities	2014-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Assets. Invements in employer securities at end of year	2014-12-31	$0
Assets. Invements in employer securities at beginning of year	2014-12-31	$0
Assets. Value of employer real property at end of year	2014-12-31	$0
Assets. Value of employer real property at beginning of year	2014-12-31	$0
Contributions received in cash from employer	2014-12-31	$139,785
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$0
Income. Dividends from preferred stock	2014-12-31	$0
Income. Dividends from common stock	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$79,780
Asset. Corporate debt instrument preferred debt at end of year	2014-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2014-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2014-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2014-12-31	$0
Contract administrator fees	2014-12-31	$5,098
Assets. Corporate common stocks other than exployer securities at end of year	2014-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2014-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2014-12-31	$0
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Aggregate proceeds on sale of assets	2014-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2014-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2014-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	MUMFORD GROUP
Accountancy firm EIN	2014-12-31	455314341

Form 5500 Responses for ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN

2020: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2019 form 5500 responses
2019-06-01	Type of plan entity	Single employer plan
2019-06-01	First time form 5500 has been submitted	Yes
2019-06-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-06-01	Plan funding arrangement – Insurance	Yes
2019-06-01	Plan funding arrangement – Trust	Yes
2019-06-01	Plan benefit arrangement – Insurance	Yes
2019-06-01	Plan benefit arrangement - Trust	Yes
2016: ALPINE HOME MEDICAL EQUIPMENT 401(K) 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	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	Yes
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: ALPINE HOME MEDICAL EQUIPMENT 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

513419

Policy instance

Insurance contract or identification number	513419
Number of Individuals Covered	123
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

940319-01

Policy instance

Insurance contract or identification number	940319-01
Number of Individuals Covered	73
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $5,736
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
Commission paid to Insurance Broker	USD $2,868
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN MUTUAL INVESTMENT SVCS

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

940319-01

Policy instance

Insurance contract or identification number	940319-01
Number of Individuals Covered	72
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,884
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
Commission paid to Insurance Broker	USD $2,442
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN MUTUAL INVESTMENT SVCS

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Company Name:	ALPINE HOME MEDICAL EQUIPMENT
Employer identification number (EIN):	870563433
NAIC Classification:	621610
NAIC Description:	Home Health Care Services