401k Plan data: GENESIS HOME CARE, INC. 401K PLAN plan

GENESIS HOME CARE, INC. 401K PLAN 401k Plan overview

Plan Name	GENESIS HOME CARE, INC. 401K PLAN
Plan identification number	001

GENESIS HOME CARE, INC. 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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

GENESIS HOME CARE, INC. has sponsored the creation of one or more 401k plans.

Company Name: GENESIS HOME CARE, INC.

Employer identification number (EIN): 752449406

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GENESIS HOME CARE, INC. 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 ANGIE MARTIN 2017-01-30 ANGIE MARTIN 2017-01-30
001 2016-01-01 ANGIE MARTIN 2017-01-03 ANGIE MARTIN 2017-01-03
001 2015-01-01 ANGIE MARTIN 2016-06-01 ANGIE MARTIN 2016-06-01
001 2014-01-01 ANGIE MARTIN
001 2013-01-01 ANGIE MARTIN
001 2012-01-01 ANGIE MARTIN ANGIE MARTIN 2013-06-25
001 2011-01-01 MAUREEN LAKE
001 2007-01-01 MAUREEN LAKE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	ANGIE MARTIN	2017-01-30	ANGIE MARTIN	2017-01-30
001	2016-01-01	ANGIE MARTIN	2017-01-03	ANGIE MARTIN	2017-01-03
001	2015-01-01	ANGIE MARTIN	2016-06-01	ANGIE MARTIN	2016-06-01
001	2014-01-01	ANGIE MARTIN
001	2013-01-01	ANGIE MARTIN
001	2012-01-01	ANGIE MARTIN		ANGIE MARTIN	2013-06-25
001	2011-01-01	MAUREEN LAKE
001	2007-01-01	MAUREEN LAKE

Plan Statistics for GENESIS HOME CARE, INC. 401K PLAN

401k plan membership statisitcs for GENESIS HOME CARE, INC. 401K PLAN

Measure Date Value
2014: GENESIS HOME CARE, INC. 401K PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 54
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 27
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 11
Total of all active and inactive participants 2014-01-01 38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 38
Number of participants with account balances 2014-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: GENESIS HOME CARE, INC. 401K PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 42
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 11
Total of all active and inactive participants 2013-01-01 53
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 53
Number of participants with account balances 2013-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: GENESIS HOME CARE, INC. 401K PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 54
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 43
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 9
Total of all active and inactive participants 2012-01-01 52
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 52
Number of participants with account balances 2012-01-01 43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: GENESIS HOME CARE, INC. 401K PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 57
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 44
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 44
Number of participants with account balances 2011-01-01 39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2007: GENESIS HOME CARE, INC. 401K PLAN 2007 401k membership
Total participants, beginning-of-year 2007-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 32
Number of retired or separated participants receiving benefits 2007-01-01 0
Number of other retired or separated participants entitled to future benefits 2007-01-01 12
Total of all active and inactive participants 2007-01-01 44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2007-01-01 0
Total participants 2007-01-01 44
Number of participants with account balances 2007-01-01 43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2007-01-01 3

Measure	Date	Value
2014: GENESIS HOME CARE, INC. 401K PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	54
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	27
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	11
Total of all active and inactive participants	2014-01-01	38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	38
Number of participants with account balances	2014-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: GENESIS HOME CARE, INC. 401K PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	42
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	11
Total of all active and inactive participants	2013-01-01	53
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	53
Number of participants with account balances	2013-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: GENESIS HOME CARE, INC. 401K PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	54
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	43
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	9
Total of all active and inactive participants	2012-01-01	52
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	52
Number of participants with account balances	2012-01-01	43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: GENESIS HOME CARE, INC. 401K PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	57
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	44
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	44
Number of participants with account balances	2011-01-01	39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2007: GENESIS HOME CARE, INC. 401K PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	32
Number of retired or separated participants receiving benefits	2007-01-01	0
Number of other retired or separated participants entitled to future benefits	2007-01-01	12
Total of all active and inactive participants	2007-01-01	44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2007-01-01	0
Total participants	2007-01-01	44
Number of participants with account balances	2007-01-01	43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2007-01-01	3

Financial Data on GENESIS HOME CARE, INC. 401K PLAN

Measure	Date	Value
2014 : GENESIS HOME CARE, INC. 401K PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$45,334
Expenses. Total of all expenses incurred	2014-12-31	$583,087
Benefits paid (including direct rollovers)	2014-12-31	$582,636
Total plan assets at end of year	2014-12-31	$453,098
Total plan assets at beginning of year	2014-12-31	$990,851
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$29,947
Expenses. Other expenses not covered elsewhere	2014-12-31	$451
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$15,387
Net income (gross income less expenses)	2014-12-31	$-537,753
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$453,098
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$990,851
Assets. Value of participant loans	2014-12-31	$59,369
Total contributions received or receivable from employer(s)	2014-12-31	$0
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
2013 : GENESIS HOME CARE, INC. 401K PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$182,041
Expenses. Total of all expenses incurred	2013-12-31	$43,283
Benefits paid (including direct rollovers)	2013-12-31	$43,031
Total plan assets at end of year	2013-12-31	$990,851
Total plan assets at beginning of year	2013-12-31	$852,093
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$83,368
Expenses. Other expenses not covered elsewhere	2013-12-31	$252
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$96,672
Net income (gross income less expenses)	2013-12-31	$138,758
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$990,851
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$852,093
Assets. Value of participant loans	2013-12-31	$34,446
Total contributions received or receivable from employer(s)	2013-12-31	$2,001
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
2012 : GENESIS HOME CARE, INC. 401K PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$231,148
Expenses. Total of all expenses incurred	2012-12-31	$56,420
Benefits paid (including direct rollovers)	2012-12-31	$56,212
Total plan assets at end of year	2012-12-31	$852,093
Total plan assets at beginning of year	2012-12-31	$677,365
Value of fidelity bond covering the plan	2012-12-31	$500,000
Total contributions received or receivable from participants	2012-12-31	$106,783
Expenses. Other expenses not covered elsewhere	2012-12-31	$208
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$70,820
Net income (gross income less expenses)	2012-12-31	$174,728
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$852,093
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$677,365
Assets. Value of participant loans	2012-12-31	$42,711
Total contributions received or receivable from employer(s)	2012-12-31	$53,545
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
2011 : GENESIS HOME CARE, INC. 401K PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$137,936
Expenses. Total of all expenses incurred	2011-12-31	$301,314
Benefits paid (including direct rollovers)	2011-12-31	$298,466
Total plan assets at end of year	2011-12-31	$677,365
Total plan assets at beginning of year	2011-12-31	$840,743
Total contributions received or receivable from participants	2011-12-31	$110,695
Expenses. Other expenses not covered elsewhere	2011-12-31	$2,848
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-28,794
Net income (gross income less expenses)	2011-12-31	$-163,378
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$677,365
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$840,743
Assets. Value of participant loans	2011-12-31	$54,918
Total contributions received or receivable from employer(s)	2011-12-31	$56,035
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : GENESIS HOME CARE, INC. 401K PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$164,102
Expenses. Total of all expenses incurred	2010-12-31	$71,979
Benefits paid (including direct rollovers)	2010-12-31	$69,167
Total plan assets at end of year	2010-12-31	$840,743
Total plan assets at beginning of year	2010-12-31	$748,620
Value of fidelity bond covering the plan	2010-12-31	$75,000
Total contributions received or receivable from participants	2010-12-31	$59,364
Expenses. Other expenses not covered elsewhere	2010-12-31	$2,812
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$76,008
Net income (gross income less expenses)	2010-12-31	$92,123
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$840,743
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$748,620
Assets. Value of participant loans	2010-12-31	$11,508
Total contributions received or receivable from employer(s)	2010-12-31	$28,730
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
2007 : GENESIS HOME CARE, INC. 401K PLAN 2007 401k financial data
Total income from all sources	2007-12-31	$155,684
Expenses. Total of all expenses incurred	2007-12-31	$5,146
Benefits paid (including direct rollovers)	2007-12-31	$5,146
Total plan assets at end of year	2007-12-31	$702,104
Total plan assets at beginning of year	2007-12-31	$551,566
Value of fidelity bond covering the plan	2007-12-31	$75,000
Total contributions received or receivable from participants	2007-12-31	$67,306
Other income received	2007-12-31	$48,126
Net income (gross income less expenses)	2007-12-31	$150,538
Net plan assets at end of year (total assets less liabilities)	2007-12-31	$702,104
Net plan assets at beginning of year (total assets less liabilities)	2007-12-31	$551,566
Assets. Value of participant loans	2007-12-31	$8,698
Total contributions received or receivable from employer(s)	2007-12-31	$40,252

Form 5500 Responses for GENESIS HOME CARE, INC. 401K PLAN

2014: GENESIS HOME CARE, INC. 401K 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 – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: GENESIS HOME CARE, INC. 401K PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: GENESIS HOME CARE, INC. 401K PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: GENESIS HOME CARE, INC. 401K PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2007: GENESIS HOME CARE, INC. 401K PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Trust	Yes
2007-01-01	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-823392

Policy instance

Insurance contract or identification number	GA-823392
Number of Individuals Covered	27
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,997
Total amount of fees paid to insurance company	USD $0
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?	Yes
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 $1,997
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVISORS INS AGENCY, LL

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

Policy contract number

GA-823392

Policy instance

Insurance contract or identification number	GA-823392
Number of Individuals Covered	34
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,444
Total amount of fees paid to insurance company	USD $0
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?	Yes
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 $2,444
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVISORS INS AGY

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

Policy contract number

GA-823392

Policy instance

Insurance contract or identification number	GA-823392
Number of Individuals Covered	43
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,151
Total amount of fees paid to insurance company	USD $0
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?	Yes
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 $2,151
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVISORS INS AGY

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

Policy contract number

GA-823392

Policy instance

Insurance contract or identification number	GA-823392
Number of Individuals Covered	39
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,401
Total amount of fees paid to insurance company	USD $0
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?	Yes
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

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

Policy contract number

GA-823392

Policy instance

Insurance contract or identification number	GA-823392
Number of Individuals Covered	40
Insurance policy start date	2010-11-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $8,046
Total amount of fees paid to insurance company	USD $0
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?	Yes
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 $8,046
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVISORS INS AGENCY LLC

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Company Name:	GENESIS HOME CARE, INC.
Employer identification number (EIN):	752449406
NAIC Classification:	621610
NAIC Description:	Home Health Care Services