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403(B) THRIFT PLAN OF AMOSKEAG HEALTH 401k Plan overview

Plan Name403(B) THRIFT PLAN OF AMOSKEAG HEALTH
Plan identification number 001

403(B) THRIFT PLAN OF AMOSKEAG HEALTH Benefits

401k Plan TypeDefined 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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • 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

AMOSKEAG HEALTH has sponsored the creation of one or more 401k plans.

Company Name:AMOSKEAG HEALTH
Employer identification number (EIN):020458174
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 403(B) THRIFT PLAN OF AMOSKEAG HEALTH

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012018-01-01
0012017-01-01JANET LANGLOIS JANET LANGLOIS2018-10-15
0012016-01-01MYRON KURTIAK
0012015-01-01MICHELE CROTEAU
0012014-01-01MICHELE CROTEAU2015-07-28
0012013-01-01MICHELE CROTEAU2014-07-28
0012012-01-01MICHELE CROTEAU2013-07-30
0012011-01-01MICHELE CROTEAU2012-07-30
0012010-01-01EDWARD GEORGE2011-08-18

Plan Statistics for 403(B) THRIFT PLAN OF AMOSKEAG HEALTH

401k plan membership statisitcs for 403(B) THRIFT PLAN OF AMOSKEAG HEALTH

Measure Date Value
2022: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2022 401k membership
Total participants, beginning-of-year2022-01-01325
Total number of active participants reported on line 7a of the Form 55002022-01-01326
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-01120
Total of all active and inactive participants2022-01-01446
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01446
Number of participants with account balances2022-01-01274
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-017
2021: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2021 401k membership
Total participants, beginning-of-year2021-01-01282
Total number of active participants reported on line 7a of the Form 55002021-01-01226
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0198
Total of all active and inactive participants2021-01-01324
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-011
Total participants2021-01-01325
Number of participants with account balances2021-01-01261
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-0135
2020: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2020 401k membership
Total participants, beginning-of-year2020-01-01260
Total number of active participants reported on line 7a of the Form 55002020-01-01193
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0189
Total of all active and inactive participants2020-01-01282
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01282
Number of participants with account balances2020-01-01251
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0135
2019: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2019 401k membership
Total participants, beginning-of-year2019-01-01315
Total number of active participants reported on line 7a of the Form 55002019-01-01191
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0169
Total of all active and inactive participants2019-01-01260
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01260
Number of participants with account balances2019-01-01246
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-016
2018: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2018 401k membership
Total participants, beginning-of-year2018-01-01254
Total number of active participants reported on line 7a of the Form 55002018-01-01252
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0163
Total of all active and inactive participants2018-01-01315
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01315
Number of participants with account balances2018-01-01246
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2017 401k membership
Total participants, beginning-of-year2017-01-01212
Total number of active participants reported on line 7a of the Form 55002017-01-01222
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0138
Total of all active and inactive participants2017-01-01260
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01260
Number of participants with account balances2017-01-01250
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2016 401k membership
Total participants, beginning-of-year2016-01-01185
Total number of active participants reported on line 7a of the Form 55002016-01-01192
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0135
Total of all active and inactive participants2016-01-01227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01227
Number of participants with account balances2016-01-01220
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2015 401k membership
Total participants, beginning-of-year2015-01-01153
Total number of active participants reported on line 7a of the Form 55002015-01-01176
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0137
Total of all active and inactive participants2015-01-01213
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01213
Number of participants with account balances2015-01-01176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010

Financial Data on 403(B) THRIFT PLAN OF AMOSKEAG HEALTH

Measure Date Value
2022 : 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$0
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total transfer of assets to this plan2022-12-31$0
Total transfer of assets from this plan2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-451,510
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$399,966
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$398,746
Expenses. Certain deemed distributions of participant loans2022-12-31$0
Value of total corrective distributions2022-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,307,938
Value of total assets at end of year2022-12-31$10,456,922
Value of total assets at beginning of year2022-12-31$11,308,398
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$1,220
Total interest from all sources2022-12-31$1,377
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$0
Assets. Real estate other than employer real property at end of year2022-12-31$0
Assets. Real estate other than employer real property at beginning of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$762,062
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Assets. Other investments not covered elsewhere at end of year2022-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$238,647
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$0
Assets. Loans (other than to participants) at end of year2022-12-31$0
Assets. Loans (other than to participants) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$0
Administrative expenses (other) incurred2022-12-31$1,220
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Income. Non cash contributions2022-12-31$0
Value of net income/loss2022-12-31$-851,476
Value of net assets at end of year (total assets less liabilities)2022-12-31$10,456,922
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$11,308,398
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Assets. partnership/joint venture interests at end of year2022-12-31$0
Assets. partnership/joint venture interests at beginning of year2022-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$9,867,530
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$10,806,043
Value of interest in pooled separate accounts at end of year2022-12-31$0
Value of interest in pooled separate accounts at beginning of year2022-12-31$0
Interest on participant loans2022-12-31$0
Income. Interest from loans (other than to participants)2022-12-31$0
Interest earned on other investments2022-12-31$1,377
Income. Interest from US Government securities2022-12-31$0
Income. Interest from corporate debt instruments2022-12-31$0
Value of interest in master investment trust accounts at end of year2022-12-31$0
Value of interest in master investment trust accounts at beginning of year2022-12-31$0
Value of interest in common/collective trusts at end of year2022-12-31$0
Value of interest in common/collective trusts at beginning of year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$589,392
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$502,355
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$0
Asset value of US Government securities at end of year2022-12-31$0
Asset value of US Government securities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$0
Net investment gain/loss from pooled separate accounts2022-12-31$-1,760,825
Net investment gain or loss from common/collective trusts2022-12-31$0
Net gain/loss from 103.12 investment entities2022-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31Yes
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$307,229
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$0
Income. Dividends from preferred stock2022-12-31$0
Income. Dividends from common stock2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$398,746
Asset. Corporate debt instrument preferred debt at end of year2022-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$0
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$0
Aggregate carrying amount (costs) on sale of assets2022-12-31$0
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31BOIVIN & ASSOCIATES, CPAS, PLCC
Accountancy firm EIN2022-12-31271516157
2021 : 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$2,474,086
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$302,255
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$300,112
Expenses. Certain deemed distributions of participant loans2021-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,099,135
Value of total assets at end of year2021-12-31$11,308,398
Value of total assets at beginning of year2021-12-31$9,136,567
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$2,143
Total interest from all sources2021-12-31$5,166
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$784,696
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$1,500
Other income not declared elsewhere2021-12-31$0
Administrative expenses (other) incurred2021-12-31$2,143
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$2,171,831
Value of net assets at end of year (total assets less liabilities)2021-12-31$11,308,398
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$9,136,567
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$10,806,043
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$8,580,512
Interest on participant loans2021-12-31$0
Interest earned on other investments2021-12-31$5,166
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$502,355
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$556,055
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$0
Net investment gain/loss from pooled separate accounts2021-12-31$1,369,785
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$312,939
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$300,112
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31BOIVIN & ASSOCIATES, CPAS, PLLC
Accountancy firm EIN2021-12-31271516157
2020 : 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$2,001,931
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$236,080
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$233,832
Expenses. Certain deemed distributions of participant loans2020-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,032,093
Value of total assets at end of year2020-12-31$9,136,567
Value of total assets at beginning of year2020-12-31$7,370,716
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$2,248
Total interest from all sources2020-12-31$4,514
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$716,201
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$19,647
Other income not declared elsewhere2020-12-31$0
Administrative expenses (other) incurred2020-12-31$2,248
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$1,765,851
Value of net assets at end of year (total assets less liabilities)2020-12-31$9,136,567
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$7,370,716
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$8,580,512
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$7,002,975
Interest on participant loans2020-12-31$0
Interest earned on other investments2020-12-31$4,514
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$556,055
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$367,741
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$0
Net investment gain/loss from pooled separate accounts2020-12-31$965,324
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$296,245
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$233,832
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31BOIVIN & ASSOCIATES, CPAS, PLLC
Accountancy firm EIN2020-12-31271516157
2019 : 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$2,162,219
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$689,393
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$687,239
Expenses. Certain deemed distributions of participant loans2019-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$986,308
Value of total assets at end of year2019-12-31$7,370,716
Value of total assets at beginning of year2019-12-31$5,897,890
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$2,154
Total interest from all sources2019-12-31$1,090,693
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$623,608
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$85,328
Other income not declared elsewhere2019-12-31$0
Administrative expenses (other) incurred2019-12-31$2,154
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$1,472,826
Value of net assets at end of year (total assets less liabilities)2019-12-31$7,370,716
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$5,897,890
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$7,002,975
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$5,716,488
Interest on participant loans2019-12-31$0
Interest earned on other investments2019-12-31$1,090,693
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$367,741
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$181,402
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Net investment gain/loss from pooled separate accounts2019-12-31$85,218
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$277,372
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$687,239
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31BOIVIN & ASSOCIATES, CPAS, PLLC
Accountancy firm EIN2019-12-31271516157
2018 : 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$453,310
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$269,691
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$269,691
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$854,571
Value of total assets at end of year2018-12-31$5,897,890
Value of total assets at beginning of year2018-12-31$5,714,271
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$0
Total interest from all sources2018-12-31$4,794
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$487,164
Participant contributions at end of year2018-12-31$0
Participant contributions at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$19,077
Administrative expenses (other) incurred2018-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$183,619
Value of net assets at end of year (total assets less liabilities)2018-12-31$5,897,890
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$5,714,271
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$5,716,488
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$5,576,452
Interest on participant loans2018-12-31$0
Interest earned on other investments2018-12-31$4,794
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$181,402
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$137,819
Net investment gain/loss from pooled separate accounts2018-12-31$-406,055
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$348,330
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$269,691
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31BOIVIN & ASSOCIATES, CPAS, PLLC
Accountancy firm EIN2018-12-31271516157
2017 : 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$1,571,898
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$160,207
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$160,207
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$889,617
Value of total assets at end of year2017-12-31$5,714,271
Value of total assets at beginning of year2017-12-31$4,302,580
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$0
Total interest from all sources2017-12-31$3,517
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$403,425
Participant contributions at end of year2017-12-31$0
Participant contributions at beginning of year2017-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$174,422
Administrative expenses (other) incurred2017-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$1,411,691
Value of net assets at end of year (total assets less liabilities)2017-12-31$5,714,271
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$4,302,580
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$5,576,452
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$4,199,653
Interest on participant loans2017-12-31$0
Interest earned on other investments2017-12-31$3,517
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$137,819
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$102,927
Net investment gain/loss from pooled separate accounts2017-12-31$678,764
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$311,770
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$160,207
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31BOLVIN & ASSOCIATES, CPAS,, PLLC
Accountancy firm EIN2017-12-31271516157
2016 : 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$984,750
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$64,779
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$64,779
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$678,239
Value of total assets at end of year2016-12-31$4,302,580
Value of total assets at beginning of year2016-12-31$3,382,609
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$0
Total interest from all sources2016-12-31$2,675
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$358,271
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$38,450
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$919,971
Value of net assets at end of year (total assets less liabilities)2016-12-31$4,302,580
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$3,382,609
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$4,199,653
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$3,303,769
Interest earned on other investments2016-12-31$2,675
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$102,927
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$78,840
Net investment gain/loss from pooled separate accounts2016-12-31$303,836
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$281,518
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$64,779
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31BOLVIN & ASSOCIATES, CPAS, PLLC
Accountancy firm EIN2016-12-31271516157
2015 : 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$995,615
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$67,977
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$67,977
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,059,787
Value of total assets at end of year2015-12-31$3,382,609
Value of total assets at beginning of year2015-12-31$2,454,971
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$0
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Funding deficiency by the employer to the plan for this plan year2015-12-31$0
Minimum employer required contribution for this plan year2015-12-31$0
Amount contributed by the employer to the plan for this plan year2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$231,931
Participant contributions at beginning of year2015-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$544,655
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$927,638
Value of net assets at end of year (total assets less liabilities)2015-12-31$3,382,609
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$2,454,971
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$3,303,769
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$2,397,167
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$78,840
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$57,804
Net investment gain/loss from pooled separate accounts2015-12-31$-64,172
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$283,201
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$67,977
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31BOIVIN & ASSOCIATES, CPAS, PLLC
Accountancy firm EIN2015-12-31271516157

Form 5500 Responses for 403(B) THRIFT PLAN OF AMOSKEAG HEALTH

2022: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: 403(B) THRIFT PLAN OF AMOSKEAG HEALTH 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number061725
Policy instance 1
Insurance contract or identification number061725
Number of Individuals Covered0
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $4,303
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
Amount paid for insurance broker fees4303
Additional information about fees paid to insurance brokerINCENTIVE COMPENSATION
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number061725H
Policy instance 1
Insurance contract or identification number061725H
Number of Individuals Covered325
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $15,816
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $0
Amount paid for insurance broker fees15816
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number061725H
Policy instance 1
Insurance contract or identification number061725H
Number of Individuals Covered282
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $15,816
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $0
Amount paid for insurance broker fees15816
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number061725H
Policy instance 1
Insurance contract or identification number061725H
Number of Individuals Covered260
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 numberGA-752166
Policy instance 1
Insurance contract or identification numberGA-752166
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $18,066
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $18,066
Amount paid for insurance broker fees0
Insurance broker organization code?3
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-752166
Policy instance 1
Insurance contract or identification numberGA-752166
Number of Individuals Covered250
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $20,022
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $20,022
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameMML INSURANCE AGENCY LLC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-752166
Policy instance 1
Insurance contract or identification numberGA-752166
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No

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