401k Plan data: CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN plan

CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN 401k Plan overview

Plan Name	CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN
Plan identification number	502

CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

CAREGIVER SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: CAREGIVER SERVICES, INC.

Employer identification number (EIN): 621645133

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2016-01-01 THOMAS HOYER
502 2016-01-01
502 2015-01-01 TOM HOYER

Plan Statistics for CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN

401k plan membership statisitcs for CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN

Measure Date Value
2016: CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 133
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 134
2015: CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 112
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 112

Measure	Date	Value
2016: CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	133
Number of retired or separated participants receiving benefits	2016-01-01	1
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	134
2015: CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	112
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	112

Form 5500 Responses for CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN

2016: CAREGIVER SERVICES, INC. DENTAL INSURANCE 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	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 – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: CAREGIVER SERVICES, INC. DENTAL INSURANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
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 – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

FLORIDA COMBINED LIFE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 76031 )

Policy contract number

CX8910

Policy instance

Insurance contract or identification number	CX8910
Number of Individuals Covered	122
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,780
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $69,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2780
Additional information about fees paid to insurance broker	SERVICE FEES PAID
Insurance broker organization code?	3
Insurance broker name	WILLIS OF FLORIDA, INC.

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Company Name:	CAREGIVER SERVICES, INC.
Employer identification number (EIN):	621645133
NAIC Classification:	621610
NAIC Description:	Home Health Care Services

Plan id#	Filing Submission Date	Name of Administrator
502	2016-01-01	THOMAS HOYER
502	2016-01-01
502	2015-01-01	TOM HOYER