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| Plan Name | COMMUNITY ACTION PROGRAM - MEDICAL PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | COMMUNITY ACTION PROGRAM - BELKNAP MERRIMACK COUNTIES INC. |
| Employer identification number (EIN): | 020270376 |
| NAIC Classification: | 624200 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2021-07-01 | JEANNE AGRI | 2022-12-22 | ||
| 503 | 2020-07-01 | JEANNE AGRI | 2022-10-14 |
| Measure | Date | Value |
|---|---|---|
| 2021: COMMUNITY ACTION PROGRAM - MEDICAL PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-07-01 | 156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 0 |
| Number of retired or separated participants receiving benefits | 2021-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-07-01 | 0 |
| Total of all active and inactive participants | 2021-07-01 | 0 |
| Number of employers contributing to the scheme | 2021-07-01 | 0 |
| 2020: COMMUNITY ACTION PROGRAM - MEDICAL PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-07-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 155 |
| Number of retired or separated participants receiving benefits | 2020-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 0 |
| Total of all active and inactive participants | 2020-07-01 | 155 |
| Number of employers contributing to the scheme | 2020-07-01 | 0 |
| 2021: COMMUNITY ACTION PROGRAM - MEDICAL PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | This submission is the final filing | Yes |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: COMMUNITY ACTION PROGRAM - MEDICAL PLAN 2020 form 5500 responses | ||
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| TUFTS HEALTH FREEDOM INSURANCE (National Association of Insurance Commissioners NAIC id number: 15737 ) | |||||||||||||||||||||||||||
| Policy contract number | 190102101727 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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| TUFTS HEALTH FREEDOM INSURANCE (National Association of Insurance Commissioners NAIC id number: 15737 ) | |||||||||||||||||||||||||||
| Policy contract number | 190102101727 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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