401k Plan data: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM plan

FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 401k Plan overview

Plan Name	FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM
Plan identification number	001

FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.

401k Sponsoring company profile

FAMILY HOSPICE OF NORTHEAST INDIANA, INC. has sponsored the creation of one or more 401k plans.

Company Name: FAMILY HOSPICE OF NORTHEAST INDIANA, INC.

Employer identification number (EIN): 352003105

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01 DERICK BAILEY 2021-07-21
001 2019-01-01 DERICK BAILEY 2020-10-12
001 2018-01-01 DERICK BAILEY 2019-10-11
001 2017-01-01 SUEANN REYNOLDS
001 2016-01-01 SUEANN REYNOLDS
001 2015-01-01 SUEANN REYNOLDS
001 2014-01-01 SUEANN REYNOLDS
001 2013-01-01 SUEANN REYNOLDS
001 2012-01-01 SUEANN REYNOLDS 2013-07-19 SUEANN REYNOLDS 2013-07-19
001 2011-01-01 SUEANN REYNOLDS 2012-06-13 SUEANN REYNOLDS 2012-06-13
001 2010-01-01 SUEANN REYNOLDS SUEANN REYNOLDS 2011-06-22
001 2009-01-01 SUEANN REYNOLDS SUEANN REYNOLDS 2010-07-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2020-01-01	DERICK BAILEY	2021-07-21
001	2019-01-01	DERICK BAILEY	2020-10-12
001	2018-01-01	DERICK BAILEY	2019-10-11
001	2017-01-01	SUEANN REYNOLDS
001	2016-01-01	SUEANN REYNOLDS
001	2015-01-01	SUEANN REYNOLDS
001	2014-01-01	SUEANN REYNOLDS
001	2013-01-01	SUEANN REYNOLDS
001	2012-01-01	SUEANN REYNOLDS	2013-07-19	SUEANN REYNOLDS	2013-07-19
001	2011-01-01	SUEANN REYNOLDS	2012-06-13	SUEANN REYNOLDS	2012-06-13
001	2010-01-01	SUEANN REYNOLDS		SUEANN REYNOLDS	2011-06-22
001	2009-01-01	SUEANN REYNOLDS		SUEANN REYNOLDS	2010-07-21

Plan Statistics for FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM

401k plan membership statisitcs for FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM

Measure Date Value
2020: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2020 401k membership
Total participants, beginning-of-year 2020-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 0
Number of participants with account balances 2020-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2019 401k membership
Total participants, beginning-of-year 2019-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 96
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 20
Total of all active and inactive participants 2019-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 116
Number of participants with account balances 2019-01-01 80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 4
2018: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2018 401k membership
Total participants, beginning-of-year 2018-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 104
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 15
Total of all active and inactive participants 2018-01-01 119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 119
Number of participants with account balances 2018-01-01 69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 10
2017: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2017 401k membership
Total participants, beginning-of-year 2017-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 114
Number of other retired or separated participants entitled to future benefits 2017-01-01 15
Total of all active and inactive participants 2017-01-01 129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 129
Number of participants with account balances 2017-01-01 60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 2
2016: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2016 401k membership
Total participants, beginning-of-year 2016-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 110
Number of other retired or separated participants entitled to future benefits 2016-01-01 19
Total of all active and inactive participants 2016-01-01 129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 129
Number of participants with account balances 2016-01-01 65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2015 401k membership
Total participants, beginning-of-year 2015-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 118
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 17
Total of all active and inactive participants 2015-01-01 135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 135
Number of participants with account balances 2015-01-01 69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 7
2014: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2014 401k membership
Total participants, beginning-of-year 2014-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 117
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 10
Total of all active and inactive participants 2014-01-01 127
Total participants 2014-01-01 127
Number of participants with account balances 2014-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 3
2013: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2013 401k membership
Total participants, beginning-of-year 2013-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 120
Number of other retired or separated participants entitled to future benefits 2013-01-01 18
Total of all active and inactive participants 2013-01-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 138
Number of participants with account balances 2013-01-01 69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2010: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2010 401k membership
Total participants, beginning-of-year 2010-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 95
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 13
Total of all active and inactive participants 2010-01-01 108
Total participants 2010-01-01 108
Number of participants with account balances 2010-01-01 85
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 6
2009: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2009 401k membership
Total participants, beginning-of-year 2009-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 90
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 21
Total of all active and inactive participants 2009-01-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 111
Number of participants with account balances 2009-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 8

Measure	Date	Value
2020: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2020 401k membership
Total participants, beginning-of-year	2020-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	0
Number of participants with account balances	2020-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2019 401k membership
Total participants, beginning-of-year	2019-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	96
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	20
Total of all active and inactive participants	2019-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	116
Number of participants with account balances	2019-01-01	80
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	4
2018: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2018 401k membership
Total participants, beginning-of-year	2018-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	104
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	15
Total of all active and inactive participants	2018-01-01	119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	119
Number of participants with account balances	2018-01-01	69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	10
2017: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2017 401k membership
Total participants, beginning-of-year	2017-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	114
Number of other retired or separated participants entitled to future benefits	2017-01-01	15
Total of all active and inactive participants	2017-01-01	129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	129
Number of participants with account balances	2017-01-01	60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	2
2016: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2016 401k membership
Total participants, beginning-of-year	2016-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	110
Number of other retired or separated participants entitled to future benefits	2016-01-01	19
Total of all active and inactive participants	2016-01-01	129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	129
Number of participants with account balances	2016-01-01	65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2015 401k membership
Total participants, beginning-of-year	2015-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	118
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	17
Total of all active and inactive participants	2015-01-01	135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	135
Number of participants with account balances	2015-01-01	69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	7
2014: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2014 401k membership
Total participants, beginning-of-year	2014-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	117
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	10
Total of all active and inactive participants	2014-01-01	127
Total participants	2014-01-01	127
Number of participants with account balances	2014-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	3
2013: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2013 401k membership
Total participants, beginning-of-year	2013-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	120
Number of other retired or separated participants entitled to future benefits	2013-01-01	18
Total of all active and inactive participants	2013-01-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	138
Number of participants with account balances	2013-01-01	69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2010: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2010 401k membership
Total participants, beginning-of-year	2010-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	95
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	13
Total of all active and inactive participants	2010-01-01	108
Total participants	2010-01-01	108
Number of participants with account balances	2010-01-01	85
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	6
2009: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2009 401k membership
Total participants, beginning-of-year	2009-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	90
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	21
Total of all active and inactive participants	2009-01-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	111
Number of participants with account balances	2009-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	8

Financial Data on FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM

Measure	Date	Value
2020 : FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total transfer of assets from this plan	2020-12-31	$121,060
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$-114,732
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$1,153,005
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$1,143,510
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$43,812
Value of total assets at end of year	2020-12-31	$0
Value of total assets at beginning of year	2020-12-31	$1,388,797
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$9,495
Total interest from all sources	2020-12-31	$215
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2020-12-31	$0
Administrative expenses professional fees incurred	2020-12-31	$5,206
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$34,116
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$33,431
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$-1,267,737
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,388,797
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$375
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,245,263
Interest on participant loans	2020-12-31	$215
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$15,197
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$15,197
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$94,906
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$-158,759
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$9,696
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$1,143,510
Contract administrator fees	2020-12-31	$3,914
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	DONONVAN P.C.
Accountancy firm EIN	2020-12-31	351356555
2019 : FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$471,538
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$423,869
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$406,513
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$270,232
Value of total assets at end of year	2019-12-31	$1,388,797
Value of total assets at beginning of year	2019-12-31	$1,341,128
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$17,356
Total interest from all sources	2019-12-31	$2,541
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$210,738
Participant contributions at end of year	2019-12-31	$33,431
Participant contributions at beginning of year	2019-12-31	$76,225
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$14,224
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$47,669
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,388,797
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,341,128
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$4,778
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,245,263
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,254,794
Interest on participant loans	2019-12-31	$2,541
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$15,197
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$10,109
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$10,109
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$94,906
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$198,765
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$45,270
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$406,513
Contract administrator fees	2019-12-31	$12,578
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	DONONVAN P.C.
Accountancy firm EIN	2019-12-31	351356555
2018 : FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$125,866
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$292,954
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$274,077
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$238,992
Value of total assets at end of year	2018-12-31	$1,341,128
Value of total assets at beginning of year	2018-12-31	$1,508,216
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$18,877
Total interest from all sources	2018-12-31	$3,275
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$170,636
Participant contributions at end of year	2018-12-31	$76,225
Participant contributions at beginning of year	2018-12-31	$71,134
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$19,093
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-167,088
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,341,128
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,508,216
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$5,196
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$1,254,794
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$1,421,994
Interest on participant loans	2018-12-31	$3,275
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$10,109
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$15,088
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$15,088
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-116,401
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$49,263
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$274,077
Contract administrator fees	2018-12-31	$13,681
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	DONONVAN P.C.
Accountancy firm EIN	2018-12-31	351356555
2017 : FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$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	$444,913
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$384,709
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$366,551
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$242,378
Value of total assets at end of year	2017-12-31	$1,508,216
Value of total assets at beginning of year	2017-12-31	$1,448,012
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$18,158
Total interest from all sources	2017-12-31	$2,098
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$142,167
Participant contributions at end of year	2017-12-31	$71,134
Participant contributions at beginning of year	2017-12-31	$48,629
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$55,327
Administrative expenses (other) incurred	2017-12-31	$2,533
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$60,204
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,508,216
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,448,012
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$2,929
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$1,421,994
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,386,835
Interest on participant loans	2017-12-31	$2,098
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$15,088
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$12,548
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$12,548
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$200,437
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$44,884
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$366,551
Contract administrator fees	2017-12-31	$12,696
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	DONONVAN P.C.
Accountancy firm EIN	2017-12-31	351356555
2016 : FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$320,754
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$107,936
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$90,883
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$194,419
Value of total assets at end of year	2016-12-31	$1,448,012
Value of total assets at beginning of year	2016-12-31	$1,235,194
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$17,053
Total interest from all sources	2016-12-31	$1,877
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$145,121
Participant contributions at end of year	2016-12-31	$48,629
Participant contributions at beginning of year	2016-12-31	$39,682
Administrative expenses (other) incurred	2016-12-31	$2,741
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$212,818
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,448,012
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,235,194
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Investment advisory and management fees	2016-12-31	$2,715
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$1,386,835
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,169,272
Interest on participant loans	2016-12-31	$1,877
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$12,548
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$26,240
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$26,240
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$124,458
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Assets. Invements in employer securities at end of year	2016-12-31	$0
Assets. Invements in employer securities at beginning of year	2016-12-31	$0
Contributions received in cash from employer	2016-12-31	$49,298
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$90,883
Contract administrator fees	2016-12-31	$11,597
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	DONONVAN P.C.
Accountancy firm EIN	2016-12-31	351356555
2015 : FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$190,944
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$333,643
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$316,312
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$213,009
Value of total assets at end of year	2015-12-31	$1,235,194
Value of total assets at beginning of year	2015-12-31	$1,377,893
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$17,331
Total interest from all sources	2015-12-31	$1,366
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$2,633
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$155,604
Participant contributions at end of year	2015-12-31	$39,682
Participant contributions at beginning of year	2015-12-31	$36,809
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$3,496
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-142,699
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,235,194
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,377,893
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Investment advisory and management fees	2015-12-31	$2,708
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,169,272
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$1,322,649
Interest on participant loans	2015-12-31	$1,366
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$26,240
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$18,435
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$18,435
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-23,431
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Assets. Invements in employer securities at end of year	2015-12-31	$0
Assets. Invements in employer securities at beginning of year	2015-12-31	$0
Contributions received in cash from employer	2015-12-31	$53,909
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$316,312
Contract administrator fees	2015-12-31	$11,990
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	DONONVAN P.C.
Accountancy firm EIN	2015-12-31	351356555
2014 : FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 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	$275,876
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$267,067
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$267,067
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$230,836
Value of total assets at end of year	2014-12-31	$1,377,893
Value of total assets at beginning of year	2014-12-31	$1,369,084
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$1,844
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	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
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
Contributions received from participants	2014-12-31	$175,419
Participant contributions at end of year	2014-12-31	$36,809
Participant contributions at beginning of year	2014-12-31	$49,927
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	$8,809
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,377,893
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,369,084
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 registered invesment companies (eg mutual funds) at end of year	2014-12-31	$1,322,649
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$1,305,819
Interest on participant loans	2014-12-31	$1,844
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$18,435
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$13,338
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$13,338
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$43,196
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	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$55,417
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$267,067
Did the plan have assets held for investment	2014-12-31	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	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	FITZGERALD ISAAC, LLC
Accountancy firm EIN	2014-12-31	263930334
2013 : FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 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	$399,285
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$99,104
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$97,269
Expenses. Certain deemed distributions of participant loans	2013-12-31	$1,835
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$226,501
Value of total assets at end of year	2013-12-31	$1,369,084
Value of total assets at beginning of year	2013-12-31	$1,068,903
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$2,171
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	$1,000,000
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	$97,269
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$171,557
Participant contributions at end of year	2013-12-31	$49,927
Participant contributions at beginning of year	2013-12-31	$57,766
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$2,427
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	$300,181
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$1,369,084
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,068,903
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 registered invesment companies (eg mutual funds) at end of year	2013-12-31	$1,318,421
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,011,137
Interest on participant loans	2013-12-31	$2,171
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$736
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$170,613
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	No
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	$52,517
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$97,269
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	FITZGERALD ISAAC, LLC
Accountancy firm EIN	2013-12-31	263930334
2010 : FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2010 401k financial data
Total income from all sources	2010-12-31	$277,900
Expenses. Total of all expenses incurred	2010-12-31	$115,369
Benefits paid (including direct rollovers)	2010-12-31	$115,369
Total plan assets at end of year	2010-12-31	$868,304
Total plan assets at beginning of year	2010-12-31	$705,773
Value of fidelity bond covering the plan	2010-12-31	$1,000,000
Total contributions received or receivable from participants	2010-12-31	$131,710
Other income received	2010-12-31	$73,556
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$162,531
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$868,304
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$705,773
Assets. Value of participant loans	2010-12-31	$47,005
Total contributions received or receivable from employer(s)	2010-12-31	$72,634
Value of certain deemed distributions of participant loans	2010-12-31	$0

Form 5500 Responses for FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM

2020: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	Yes
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 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	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
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: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 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: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 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: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 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
2010: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: FAMILY HOSPICE OF N.E. INDIANA EMPLOYEES TAX-DEF. ANNUITY PROGRAM 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

Insurance Providers Used on plan

NATIONWIDE TRUST COMPANY FSB (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

BOA2

Policy instance

Insurance contract or identification number	BOA2
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	Yes
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

NATIONWIDE TRUST COMPANY FSB (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

BOA2

Policy instance

Insurance contract or identification number	BOA2
Number of Individuals Covered	2
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	Yes
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

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Company Name:	FAMILY HOSPICE OF NORTHEAST INDIANA, INC.
Employer identification number (EIN):	352003105
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations