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DocuSign Envelope ID: D246BF38-3F94-4A4B-B6B9-C4F5BAC37487 <br /> SCHEDULE OF OPERATIONS FOR: PAGE: 2 <br /> ***** PREMIUM INFORMATION FOR NC ***** <br /> Right at Home Carrier Policy # : WC100-000481-116 <br /> KAH Care, LLC Fein: <br /> Ken Helmuth <br /> 4905 Pine Cone Drive, Suite 2 <br /> Durham, NC 27707 <br /> Code Classification Payroll Rate Premium <br /> 8742 SALESPERSONS COLLECTORS 0 19, 657 . 53 . 63 124 . 00 <br /> ( 5/05/16- 2/16/17) <br /> 8810 CLERICAL OFFICE EMPLOYEES 51, 109 . 59 .26 133 . 00 <br /> ( 5/05/16- 2/16/17) <br /> 8835 NURSING-HOME HEALTH PUBLI 530, 753 .42 4 . 19 22, 239 . 00 <br /> ( 5/05/16- 2/16/17) <br /> 8742 SALESPERSONS COLLECTORS 0 5, 342 .47 . 67 36 . 00 <br /> ( 2/16/17- 5/05/17) <br /> 8810 CLERICAL OFFICE EMPLOYEES 13 , 890 . 41 . 23 32 . 00 <br /> ( 2/16/17- 5/05/17) <br /> 8835 NURSING-HOME HEALTH PUBLI 144, 246 . 58 4 . 08 5, 885 . 00 <br /> ( 2/16/17- 5/05/17) <br /> Manual Premium 28, 449 . 00 <br /> Increased Employers Liability Limits 1 .400% 398 . 00 <br /> Experience Modification - Listed below 54, 809 . 00 <br /> Schedule Debit 1 . 1000 5, 481 . 00 <br /> Standard Premium 60, 290 . 00 <br /> Premium Discount 10 . 00% 6, 027 . 00 <br /> Normal Premium 54, 263 . 00 <br /> Expense Constant 250 . 00 <br /> TERRORISM 125 . 00 <br /> CATASTROPHE 125 . 00 <br /> Annual Premium 54, 763 . 00 <br /> Experience Modifiers <br /> 1 . 9000 2/16/2016 <br /> WC 00 00 01 B <br />