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| Plan Name | MERRIMACK VALLEY YMCA HEALTH AND WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | MERRIMACK VALLEY YMCA |
| Employer identification number (EIN): | 042104378 |
| NAIC Classification: | 713900 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2019-01-01 | JANE DINSMORE | 2020-06-24 | ||
| 501 | 2018-01-01 |
| 2019: MERRIMACK VALLEY YMCA HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses | ||
|---|---|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: MERRIMACK VALLEY YMCA HEALTH AND WELFARE BENEFIT PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | First time form 5500 has been submitted | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 98085101001 |
| Policy instance | 5 |
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) | |
| Policy contract number | C004447586C01 |
| Policy instance | 4 |
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) | |
| Policy contract number | C004447586C01 |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 93090 |
| Policy instance | 2 |
| ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) | |
| Policy contract number | 6357-1 |
| Policy instance | 1 |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 98085101001 |
| Policy instance | 5 |
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) | |
| Policy contract number | C004447586C01 |
| Policy instance | 4 |
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) | |
| Policy contract number | C004447586C01 |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) | |
| Policy contract number | 93090 |
| Policy instance | 2 |
| ALTUS DENTAL INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 52632 ) | |
| Policy contract number | 6357-1 |
| Policy instance | 1 |
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