401k Plan data: SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN plan

SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN 401k Plan overview

Plan Name	SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN
Plan identification number	002

SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN Benefits

401k Plan Type

Defined 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.
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

BUSALACCHI ENTERPRISES, INC. DBA SYNERGY HOME CARE OF MILWAUKEE COUNTY has sponsored the creation of one or more 401k plans.

Company Name: BUSALACCHI ENTERPRISES, INC. DBA SYNERGY HOME CARE OF MILWAUKEE COUNTY

Employer identification number (EIN): 271838733

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01 RUTH BUSALACCHI
002 2015-01-01 RUTH BUSALACCHI
002 2014-01-01 RUTH BUSALACCHI
002 2013-01-15 FRANK HARRISON 2014-08-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2016-01-01	RUTH BUSALACCHI
002	2015-01-01	RUTH BUSALACCHI
002	2014-01-01	RUTH BUSALACCHI
002	2013-01-15	FRANK HARRISON	2014-08-15

Plan Statistics for SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN

401k plan membership statisitcs for SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN

Measure Date Value
2016: SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 27
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 24
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 3
Total of all active and inactive participants 2015-01-01 27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 27
Number of participants with account balances 2015-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 13
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 1
Total of all active and inactive participants 2014-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 14
Number of participants with account balances 2014-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2016: SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	24
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	3
Total of all active and inactive participants	2015-01-01	27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	27
Number of participants with account balances	2015-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	13
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	1
Total of all active and inactive participants	2014-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	14
Number of participants with account balances	2014-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN

Measure	Date	Value
2016 : SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN 2016 401k financial data
Total income from all sources	2016-12-30	$357,516
Expenses. Total of all expenses incurred	2016-12-30	$717,921
Benefits paid (including direct rollovers)	2016-12-30	$717,642
Total plan assets at end of year	2016-12-30	$0
Total plan assets at beginning of year	2016-12-30	$360,405
Value of fidelity bond covering the plan	2016-12-30	$400,000
Expenses. Other expenses not covered elsewhere	2016-12-30	$279
Contributions received from other sources (not participants or employers)	2016-12-30	$109
Other income received	2016-12-30	$357,407
Net income (gross income less expenses)	2016-12-30	$-360,405
Net plan assets at end of year (total assets less liabilities)	2016-12-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-12-30	$360,405
Assets. Value of employer securities	2016-12-30	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-30	$703,020
2015 : SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$-15,013
Expenses. Total of all expenses incurred	2015-12-31	$1,140
Benefits paid (including direct rollovers)	2015-12-31	$970
Total plan assets at end of year	2015-12-31	$360,405
Total plan assets at beginning of year	2015-12-31	$376,558
Value of fidelity bond covering the plan	2015-12-31	$400,000
Total contributions received or receivable from participants	2015-12-31	$2,359
Other income received	2015-12-31	$-17,372
Net income (gross income less expenses)	2015-12-31	$-16,153
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$360,405
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$376,558
Assets. Value of employer securities	2015-12-31	$346,077
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$170
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$221,291
Total income from all sources	2014-12-31	$146,581
Expenses. Total of all expenses incurred	2014-12-31	$1,518
Benefits paid (including direct rollovers)	2014-12-31	$1,398
Total plan assets at end of year	2014-12-31	$376,558
Total plan assets at beginning of year	2014-12-31	$10,204
Total contributions received or receivable from participants	2014-12-31	$4,365
Other income received	2014-12-31	$142,116
Net income (gross income less expenses)	2014-12-31	$145,063
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$376,558
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$10,204
Assets. Value of employer securities	2014-12-31	$362,918
Total contributions received or receivable from employer(s)	2014-12-31	$100
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$120
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0

Form 5500 Responses for SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN

2016: SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: SYNERGY HOME CARE OF MILWAUKEE COUNTY 401(K) 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	No
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: SYNERGY HOME CARE OF MILWAUKEE COUNTY 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-832516

Policy instance

Insurance contract or identification number	GA-832516
Number of Individuals Covered	6
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $48
Total amount of fees paid to insurance company	USD $2
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 $37
Insurance broker organization code?	3
Amount paid for insurance broker fees	2
Additional information about fees paid to insurance broker	ADMINISTRATIVE ALLOWANCE
Insurance broker name	DYATECH LLC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-832516

Policy instance

Insurance contract or identification number	GA-832516
Number of Individuals Covered	6
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $54
Total amount of fees paid to insurance company	USD $6
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 $54
Insurance broker organization code?	3
Amount paid for insurance broker fees	6
Additional information about fees paid to insurance broker	ADMINISTRATIVE ALLOWANCE
Insurance broker name	DYATECH LLC

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Company Name:	BUSALACCHI ENTERPRISES, INC. DBA SYNERGY HOME CARE OF MILWAUKEE COUNTY
Employer identification number (EIN):	271838733
NAIC Classification:	621610
NAIC Description:	Home Health Care Services