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HOME INSTEAD SENIOR CARE 401(K) PLAN 401k Plan overview

Plan NameHOME INSTEAD SENIOR CARE 401(K) PLAN
Plan identification number 001

HOME INSTEAD SENIOR CARE 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • 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.
  • Plan not intended to be qualified - A plan not intended to be qualified under Code sections 401, 403, or 408.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ROTH SENIOR CARE, LLC DBA HOME INSTEAD SENIOR CARE has sponsored the creation of one or more 401k plans.

Company Name:ROTH SENIOR CARE, LLC DBA HOME INSTEAD SENIOR CARE
Employer identification number (EIN):262679126
NAIC Classification:621610
NAIC Description:Home Health Care Services

Additional information about ROTH SENIOR CARE, LLC DBA HOME INSTEAD SENIOR CARE

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2008-05-27
Company Identification Number: 52128296
Legal Registered Office Address: 10415 SE STARK ST STE A

PORTLAND
United States of America (USA)
97216

More information about ROTH SENIOR CARE, LLC DBA HOME INSTEAD SENIOR CARE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOME INSTEAD SENIOR CARE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01PRESTON ROTH2023-09-25
0012021-01-01PRESTON ROTH2022-08-25 PRESTON ROTH2022-08-25
0012020-01-01PRESTON ROTH2021-10-11
0012019-01-01PRESTON ROTH2020-09-03
0012018-01-01PRESTON ROTH2019-09-27
0012017-01-01PRESTON ROTH
0012016-01-01PRESTON ROTH
0012016-01-01

Plan Statistics for HOME INSTEAD SENIOR CARE 401(K) PLAN

401k plan membership statisitcs for HOME INSTEAD SENIOR CARE 401(K) PLAN

Measure Date Value
2017: HOME INSTEAD SENIOR CARE 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01112
Total number of active participants reported on line 7a of the Form 55002017-01-0179
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-013
Total of all active and inactive participants2017-01-0182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0182
Number of participants with account balances2017-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: HOME INSTEAD SENIOR CARE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01112
Total number of active participants reported on line 7a of the Form 55002016-01-01111
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-011
Total of all active and inactive participants2016-01-01112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01112
Number of participants with account balances2016-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010

Financial Data on HOME INSTEAD SENIOR CARE 401(K) PLAN

Measure Date Value
2017 : HOME INSTEAD SENIOR CARE 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$86,667
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$3,956
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$860
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$58,670
Value of total assets at end of year2017-12-31$268,488
Value of total assets at beginning of year2017-12-31$185,777
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$3,096
Total interest from all sources2017-12-31$137
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$100,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$46,840
Participant contributions at end of year2017-12-31$0
Participant contributions at beginning of year2017-12-31$653
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$82,711
Value of net assets at end of year (total assets less liabilities)2017-12-31$268,488
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$185,777
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$167,638
Value of interest in pooled separate accounts at end of year2017-12-31$242,035
Value of interest in pooled separate accounts at beginning of year2017-12-31$0
Interest earned on other investments2017-12-31$137
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$25,836
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$16,130
Net investment gain/loss from pooled separate accounts2017-12-31$27,860
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31Yes
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$11,830
Employer contributions (assets) at end of year2017-12-31$617
Employer contributions (assets) at beginning of year2017-12-31$1,356
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$860
Contract administrator fees2017-12-31$3,096
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31CRAMER & ASSOCIATES
Accountancy firm EIN2017-12-31272044619
2016 : HOME INSTEAD SENIOR CARE 401(K) PLAN 2016 401k financial data
Total income from all sources (including contributions)2016-12-31$188,549
Total of all expenses incurred2016-12-31$1,997
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$166,238
Value of total assets at end of year2016-12-31$186,552
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$1,997
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$100,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$26,282
Participant contributions at end of year2016-12-31$1,353
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$129,145
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$186,552
Value of net assets at end of year (total assets less liabilities)2016-12-31$186,552
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$167,638
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$16,130
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$22,311
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31Yes
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$10,811
Employer contributions (assets) at end of year2016-12-31$1,431
Contract administrator fees2016-12-31$1,997
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31CRAMER & ASSOCIATES
Accountancy firm EIN2016-12-31272044619

Form 5500 Responses for HOME INSTEAD SENIOR CARE 401(K) PLAN

2017: HOME INSTEAD SENIOR CARE 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: HOME INSTEAD SENIOR CARE 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
2016-01-01Submission has been amendedYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number601894-000
Policy instance 1
Insurance contract or identification number601894-000
Number of Individuals Covered15
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,021
Total amount of fees paid to insurance companyUSD $117
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $1,021
Insurance broker organization code?3
Amount paid for insurance broker fees117
Additional information about fees paid to insurance brokerPLAN EXPENSE
Insurance broker namePREMIER RETIREMENT SERVICES, INC.

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