401k Plan data: HOME CARE HOME BASE, LP 401(K) PLAN plan

HOME CARE HOME BASE, LP 401(K) PLAN 401k Plan overview

Plan Name	HOME CARE HOME BASE, LP 401(K) PLAN
Plan identification number	101

HOME CARE HOME BASE, LP 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.
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

HOME CARE HOME BASE, LP has sponsored the creation of one or more 401k plans.

Company Name: HOME CARE HOME BASE, LP

Employer identification number (EIN): 611398849

NAIC Classification: 518210
NAIC Description: Data Processing, Hosting, and Related Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOME CARE HOME BASE, LP 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
101 2014-01-01 PHIL TISUE
101 2014-01-01 PHIL TISUE
101 2013-01-01 PHIL TISUE
101 2012-01-01 PHIL TISUE

Plan id#	Filing Submission Date	Name of Administrator
101	2014-01-01	PHIL TISUE
101	2014-01-01	PHIL TISUE
101	2013-01-01	PHIL TISUE
101	2012-01-01	PHIL TISUE

Plan Statistics for HOME CARE HOME BASE, LP 401(K) PLAN

401k plan membership statisitcs for HOME CARE HOME BASE, LP 401(K) PLAN

Measure Date Value
2014: HOME CARE HOME BASE, LP 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
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 0
Total of all active and inactive participants 2014-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 0
Number of participants with account balances 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: HOME CARE HOME BASE, LP 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 288
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 258
Number of retired or separated participants receiving benefits 2013-01-01 7
Number of other retired or separated participants entitled to future benefits 2013-01-01 54
Total of all active and inactive participants 2013-01-01 319
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 319
Number of participants with account balances 2013-01-01 248
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: HOME CARE HOME BASE, LP 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 238
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 50
Total of all active and inactive participants 2012-01-01 288
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 288
Number of participants with account balances 2012-01-01 221
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2014: HOME CARE HOME BASE, LP 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
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	0
Total of all active and inactive participants	2014-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	0
Number of participants with account balances	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: HOME CARE HOME BASE, LP 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	288
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	258
Number of retired or separated participants receiving benefits	2013-01-01	7
Number of other retired or separated participants entitled to future benefits	2013-01-01	54
Total of all active and inactive participants	2013-01-01	319
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	319
Number of participants with account balances	2013-01-01	248
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: HOME CARE HOME BASE, LP 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	238
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	50
Total of all active and inactive participants	2012-01-01	288
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	288
Number of participants with account balances	2012-01-01	221
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on HOME CARE HOME BASE, LP 401(K) PLAN

Measure	Date	Value
2014 : HOME CARE HOME BASE, LP 401(K) PLAN 2014 401k financial data
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
Total income from all sources (including contributions)	2014-12-31	$64,884
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$5,405,107
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$5,395,474
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$0
Value of total assets at end of year	2014-12-31	$0
Value of total assets at beginning of year	2014-12-31	$5,340,223
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$9,633
Total interest from all sources	2014-12-31	$1,006
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	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2014-12-31	$0
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
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
Participant contributions at end of year	2014-12-31	$0
Participant contributions 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
Value of net income/loss	2014-12-31	$-5,340,223
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$5,340,223
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
Value of interest in pooled separate accounts at end of year	2014-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$5,001,061
Interest earned on other investments	2014-12-31	$1,006
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$314,516
Net investment gain/loss from pooled separate accounts	2014-12-31	$63,878
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	Yes
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Employer contributions (assets) at end of year	2014-12-31	$0
Employer contributions (assets) at beginning of year	2014-12-31	$24,646
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$5,395,474
Contract administrator fees	2014-12-31	$9,633
Did the plan have assets held for investment	2014-12-31	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	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
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	COULTER & JUSTUS
Accountancy firm EIN	2014-12-31	621532536
2013 : HOME CARE HOME BASE, LP 401(K) PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$2,244,244
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$393,424
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$365,397
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,495,801
Value of total assets at end of year	2013-12-31	$5,340,223
Value of total assets at beginning of year	2013-12-31	$3,489,403
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$28,027
Total interest from all sources	2013-12-31	$4,428
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$959,709
Participant contributions at end of year	2013-12-31	$24,646
Participant contributions at beginning of year	2013-12-31	$90,157
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$1,850,820
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$5,340,223
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$3,489,403
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$5,001,061
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$3,214,385
Interest earned on other investments	2013-12-31	$4,428
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$314,516
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$145,777
Net investment gain/loss from pooled separate accounts	2013-12-31	$744,015
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$536,092
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$39,084
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$365,397
Contract administrator fees	2013-12-31	$28,027
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	COULTER & JUSTUS
Accountancy firm EIN	2013-12-31	621532536
2012 : HOME CARE HOME BASE, LP 401(K) PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total transfer of assets to this plan	2012-12-31	$1,739,747
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	$1,905,470
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$155,814
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$130,402
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,662,535
Value of total assets at end of year	2012-12-31	$3,489,403
Value of total assets at beginning of year	2012-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$25,412
Total interest from all sources	2012-12-31	$2,022
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	$500,000
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	$1,128,517
Participant contributions at end of year	2012-12-31	$90,157
Participant contributions at beginning of year	2012-12-31	$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	2012-12-31	No
Value of net income/loss	2012-12-31	$1,749,656
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$3,489,403
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$0
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	$3,214,385
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$0
Interest earned on other investments	2012-12-31	$2,022
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$145,777
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$0
Net investment gain/loss from pooled separate accounts	2012-12-31	$240,913
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	Yes
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	$534,018
Employer contributions (assets) at end of year	2012-12-31	$39,084
Employer contributions (assets) at beginning of year	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$130,402
Contract administrator fees	2012-12-31	$25,412
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	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	COULTER & JUSTUS
Accountancy firm EIN	2012-12-31	621532536

Form 5500 Responses for HOME CARE HOME BASE, LP 401(K) PLAN

2014: HOME CARE HOME BASE, LP 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
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 funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: HOME CARE HOME BASE, LP 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: HOME CARE HOME BASE, LP 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

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

Policy contract number

931061-048

Policy instance

Insurance contract or identification number	931061-048
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,027
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 $4,039
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	0.00
Insurance broker organization code?	3
Insurance broker name	RAYMOND JAMES INSURANCE GROUP INC

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

Policy contract number

931061-048

Policy instance

Insurance contract or identification number	931061-048
Number of Individuals Covered	319
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $16,869
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	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 $14,581
Insurance broker organization code?	3
Insurance broker name	MORGAN KEEGAN & CO INC

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

Policy contract number

931061-048

Policy instance

Insurance contract or identification number	931061-048
Number of Individuals Covered	288
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $9,913
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	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 $9,913
Insurance broker organization code?	3
Insurance broker name	MORGAN KEEGAN & CO

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Company Name:	HOME CARE HOME BASE, LP
Employer identification number (EIN):	611398849
NAIC Classification:	518210
NAIC Description:	Data Processing, Hosting, and Related Services