401k Plan data: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN plan

COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN
Plan identification number	001

COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING 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.
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.
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

COVENANT CARE, LLC has sponsored the creation of one or more 401k plans.

Company Name: COVENANT CARE, LLC

Employer identification number (EIN): 770396904

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Additional information about COVENANT CARE, LLC

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 2003-10-01

Company Identification Number: 602325509

Legal Registered Office Address: 4246 WILLIAMS AVE W

SEATTLE
United States of America (USA)
981991544

More information about COVENANT CARE, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01
001 2014-01-01
001 2013-01-01
001 2012-01-01 JACK O'SULLIVAN JACK O'SULLIVAN 2013-10-15
001 2011-01-01 MARGARITE ALVAREZ MARGARITE ALVAREZ 2012-11-20
001 2009-01-01 MARGARITE ALVAREZ MARGARITE ALVAREZ 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2015-01-01
001	2014-01-01
001	2013-01-01
001	2012-01-01	JACK O'SULLIVAN	JACK O'SULLIVAN	2013-10-15
001	2011-01-01	MARGARITE ALVAREZ	MARGARITE ALVAREZ	2012-11-20
001	2009-01-01	MARGARITE ALVAREZ	MARGARITE ALVAREZ	2010-10-14

Plan Statistics for COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2015: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 24
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
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 29
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 9
Total of all active and inactive participants 2014-01-01 38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 38
Number of participants with account balances 2014-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 86
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 27
Total of all active and inactive participants 2013-01-01 27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 27
Number of participants with account balances 2013-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 84
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 29
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 57
Total of all active and inactive participants 2012-01-01 86
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 86
Number of participants with account balances 2012-01-01 78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 25
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 87
Total of all active and inactive participants 2011-01-01 112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 112
Number of participants with account balances 2011-01-01 108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 3
2009: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 29
Number of retired or separated participants receiving benefits 2009-01-01 5
Number of other retired or separated participants entitled to future benefits 2009-01-01 82
Total of all active and inactive participants 2009-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 116
Number of participants with account balances 2009-01-01 113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 9

Measure	Date	Value
2015: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	24
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
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	29
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	9
Total of all active and inactive participants	2014-01-01	38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	38
Number of participants with account balances	2014-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	86
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	27
Total of all active and inactive participants	2013-01-01	27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	27
Number of participants with account balances	2013-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	84
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	29
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	57
Total of all active and inactive participants	2012-01-01	86
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	86
Number of participants with account balances	2012-01-01	78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	25
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	87
Total of all active and inactive participants	2011-01-01	112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	112
Number of participants with account balances	2011-01-01	108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	3
2009: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	29
Number of retired or separated participants receiving benefits	2009-01-01	5
Number of other retired or separated participants entitled to future benefits	2009-01-01	82
Total of all active and inactive participants	2009-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	116
Number of participants with account balances	2009-01-01	113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	9

Financial Data on COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2015 : COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$-362,702
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$1,022
Expenses. Total of all expenses incurred	2015-12-31	$9,141
Benefits paid (including direct rollovers)	2015-12-31	$8,826
Total plan assets at end of year	2015-12-31	$0
Total plan assets at beginning of year	2015-12-31	$370,821
Value of fidelity bond covering the plan	2015-12-31	$40,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$315
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$1,022
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-8,119
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$370,821
Total contributions received or receivable from employer(s)	2015-12-31	$0
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$17,640
Expenses. Total of all expenses incurred	2014-12-31	$16,771
Benefits paid (including direct rollovers)	2014-12-31	$14,569
Total plan assets at end of year	2014-12-31	$370,821
Total plan assets at beginning of year	2014-12-31	$369,952
Value of fidelity bond covering the plan	2014-12-31	$40,000
Total contributions received or receivable from participants	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$17,640
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$869
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$370,821
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$369,952
Assets. Value of participant loans	2014-12-31	$52,170
Total contributions received or receivable from employer(s)	2014-12-31	$0
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$2,202
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$61,396
Expenses. Total of all expenses incurred	2013-12-31	$47,381
Benefits paid (including direct rollovers)	2013-12-31	$46,646
Total plan assets at end of year	2013-12-31	$369,952
Total plan assets at beginning of year	2013-12-31	$355,937
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$61,396
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$14,015
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$369,952
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$355,937
Assets. Value of participant loans	2013-12-31	$64,997
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$735
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$-114,008
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$47,384
Expenses. Total of all expenses incurred	2012-12-31	$14,321
Benefits paid (including direct rollovers)	2012-12-31	$12,871
Total plan assets at end of year	2012-12-31	$356,197
Total plan assets at beginning of year	2012-12-31	$437,142
Value of fidelity bond covering the plan	2012-12-31	$10,000
Total contributions received or receivable from participants	2012-12-31	$16,007
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$31,377
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$33,063
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$356,197
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$437,142
Assets. Value of participant loans	2012-12-31	$46,160
Total contributions received or receivable from employer(s)	2012-12-31	$0
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$1,450
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$-37,745
Expenses. Total of all expenses incurred	2011-12-31	$24,199
Benefits paid (including direct rollovers)	2011-12-31	$24,199
Total plan assets at end of year	2011-12-31	$562,050
Total plan assets at beginning of year	2011-12-31	$623,994
Value of fidelity bond covering the plan	2011-12-31	$10,000
Total contributions received or receivable from participants	2011-12-31	$4,528
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-42,273
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-61,944
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$562,050
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$623,994
Assets. Value of participant loans	2011-12-31	$115,900
Total contributions received or receivable from employer(s)	2011-12-31	$0
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$51,928
Expenses. Total of all expenses incurred	2010-12-31	$69,659
Benefits paid (including direct rollovers)	2010-12-31	$68,747
Total plan assets at end of year	2010-12-31	$623,994
Total plan assets at beginning of year	2010-12-31	$641,725
Value of fidelity bond covering the plan	2010-12-31	$10,000
Total contributions received or receivable from participants	2010-12-31	$11,577
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$40,351
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$-17,731
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$623,994
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$641,725
Assets. Value of participant loans	2010-12-31	$125,886
Total contributions received or receivable from employer(s)	2010-12-31	$0
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$912
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN

2015: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING 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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: COASTAL HOME CARE SERVICES, INC. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	COVENANT CARE, LLC
Employer identification number (EIN):	770396904
NAIC Classification:	621610
NAIC Description:	Home Health Care Services

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	2003-10-01
Company Identification Number:	602325509
Legal Registered Office Address:	4246 WILLIAMS AVE W SEATTLE United States of America (USA) 981991544