Countryside Hospice Care, Inc.

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2005-12-15
Business code	621610
Sponsor’s telephone number	2562319190
Plan sponsor’s mailing address	620 QUINTARD AVE, ANNISTON, AL, 36201
Plan sponsor’s address	620 QUINTARD AVE, ANNISTON, AL, 36201

Plan administrator’s name and address

Administrator’s EIN	330871951
Plan administrator’s name	COUNTRYSIDE HOSPICE CARE, INC.
Plan administrator’s address	620 QUINTARD AVE, ANNISTON, AL, 36201
Administrator’s telephone number	2562319190

Number of participants as of the end of the plan year

Active participants	102
Retired or separated participants receiving benefits	0
Other retired or separated participants entitled to future benefits	22
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits	1
Number of participants with account balances as of the end of the plan year	69
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	0

Signature of

Role	Plan administrator
Date	2010-12-22
Name of individual signing	NANCY JAKUS
Valid signature	Filed with authorized/valid electronic signature