401k Plan data: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT plan

HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 401k Plan overview

Plan Name	HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT
Plan identification number	501

HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT Benefits

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

401k Sponsoring company profile

HOMECARE DIMENSIONS has sponsored the creation of one or more 401k plans.

Company Name: HOMECARE DIMENSIONS

Employer identification number (EIN): 742758644

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-07-01
501 2015-07-01 JOHN OLIVAS JOHN OLIVAS 2017-01-30
501 2014-07-01 JOHN OLIVAS JOHN OLIVAS 2017-01-30
501 2013-07-01 JOHN OLIVAS JOHN OLIVAS 2017-01-30

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2016-07-01
501	2015-07-01	JOHN OLIVAS	JOHN OLIVAS	2017-01-30
501	2014-07-01	JOHN OLIVAS	JOHN OLIVAS	2017-01-30
501	2013-07-01	JOHN OLIVAS	JOHN OLIVAS	2017-01-30

Plan Statistics for HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT

401k plan membership statisitcs for HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT

Measure Date Value
2016: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2016 401k membership
Total participants, beginning-of-year 2016-07-01 301
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 0
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 0
2015: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2015 401k membership
Total participants, beginning-of-year 2015-07-01 193
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 301
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 301
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-07-01 0
Total participants 2015-07-01 301
Number of participants with account balances 2015-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-07-01 0
2014: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2014 401k membership
Total participants, beginning-of-year 2014-07-01 118
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 193
Total of all active and inactive participants 2014-07-01 193
Total participants 2014-07-01 193
2013: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2013 401k membership
Total participants, beginning-of-year 2013-07-01 118
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 118
Total of all active and inactive participants 2013-07-01 118
Total participants 2013-07-01 118

Measure	Date	Value
2016: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2016 401k membership
Total participants, beginning-of-year	2016-07-01	301
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	0
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	0
2015: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2015 401k membership
Total participants, beginning-of-year	2015-07-01	193
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	301
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	301
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-07-01	0
Total participants	2015-07-01	301
Number of participants with account balances	2015-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-07-01	0
2014: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2014 401k membership
Total participants, beginning-of-year	2014-07-01	118
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	193
Total of all active and inactive participants	2014-07-01	193
Total participants	2014-07-01	193
2013: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2013 401k membership
Total participants, beginning-of-year	2013-07-01	118
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	118
Total of all active and inactive participants	2013-07-01	118
Total participants	2013-07-01	118

Form 5500 Responses for HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT

2016: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	Yes
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: HOME CARE DIMENSIONS EMPLOYEE HEALTH BENEFIT 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	First time form 5500 has been submitted	Yes
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

147235

Policy instance

Insurance contract or identification number	147235
Number of Individuals Covered	301
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $65,765
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	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
Welfare Benefit Premiums Paid to Carrier	USD $1,371,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,883
Insurance broker name	RIEL KNUTH

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

147235

Policy instance

Insurance contract or identification number	147235
Number of Individuals Covered	193
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $39,981
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	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
Welfare Benefit Premiums Paid to Carrier	USD $832,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,990
Insurance broker name	TRACEY ANN WELK

HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )

Policy contract number

701184

Policy instance

Insurance contract or identification number	701184
Number of Individuals Covered	118
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $24,900
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	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
Welfare Benefit Premiums Paid to Carrier	USD $522,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,476
Insurance broker name	TRACEY ANN TUCKER

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Company Name:	HOMECARE DIMENSIONS
Employer identification number (EIN):	742758644
NAIC Classification:	621610
NAIC Description:	Home Health Care Services