401k Plan data: THE VNA & HOSPICE OF THE SOUTHWEST REGION MEDICAL PLAN plan

THE VNA & HOSPICE OF THE SOUTHWEST REGION MEDICAL PLAN 401k Plan overview

Plan Name	THE VNA & HOSPICE OF THE SOUTHWEST REGION MEDICAL PLAN
Plan identification number	502

THE VNA & HOSPICE OF THE SOUTHWEST REGION MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Vision

401k Sponsoring company profile

VNA & HOSPICE OF THE SOUTHWEST REGION has sponsored the creation of one or more 401k plans.

Company Name: VNA & HOSPICE OF THE SOUTHWEST REGION

Employer identification number (EIN): 030185024

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE VNA & HOSPICE OF THE SOUTHWEST REGION MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-01-01 HARRY SNYDER HARRY SNYDER 2016-07-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2015-01-01	HARRY SNYDER		HARRY SNYDER	2016-07-29

Plan Statistics for THE VNA & HOSPICE OF THE SOUTHWEST REGION MEDICAL PLAN

401k plan membership statisitcs for THE VNA & HOSPICE OF THE SOUTHWEST REGION MEDICAL PLAN

Measure Date Value
2015: THE VNA & HOSPICE OF THE SOUTHWEST REGION MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
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 0

Measure	Date	Value
2015: THE VNA & HOSPICE OF THE SOUTHWEST REGION MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
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	0

Form 5500 Responses for THE VNA & HOSPICE OF THE SOUTHWEST REGION MEDICAL PLAN

2015: THE VNA & HOSPICE OF THE SOUTHWEST REGION MEDICAL PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	Yes
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

Insurance Providers Used on plan

BLUE CROSS AND BLUE SHIELD OF VERMONT (National Association of Insurance Commissioners NAIC id number: 53295 )

Policy contract number

81342

Policy instance

Insurance contract or identification number	81342
Number of Individuals Covered	31
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $10,526
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?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $298,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,526
Insurance broker organization code?	3
Insurance broker name	CLINTON THOMAS LIFE CORP.

THE VERMONT HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95696 )

Policy contract number

T81342

Policy instance

Insurance contract or identification number	T81342
Number of Individuals Covered	124
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $59,826
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?	No
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $1,444,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $59,826
Insurance broker organization code?	3
Insurance broker name	CLINTON THOMAS LIFE CORP.

Potentially related plans

THE VNA OF GREATER CINCINNATI & N. KY. RETIREMENT PLAN [EIN = 310536716]

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Company Name:	VNA & HOSPICE OF THE SOUTHWEST REGION
Employer identification number (EIN):	030185024
NAIC Classification:	621610
NAIC Description:	Home Health Care Services