401k Plan data: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN plan

AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 401k Plan overview

Plan Name	AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN
Plan identification number	017

AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Money purchase (other than target benefit)
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.
Participant-directed brokerage accounts provided as an investment option under the plan.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

AMR HOLDCO, INC. has sponsored the creation of one or more 401k plans.

Company Name: AMR HOLDCO, INC.

Employer identification number (EIN): 202076468

NAIC Classification: 621900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
017 2022-01-01
017 2021-01-01
017 2020-01-01
017 2019-01-01
017 2018-01-01

Plan Statistics for AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN

401k plan membership statisitcs for AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN

Measure Date Value
2022: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 50
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 36
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 10
Total of all active and inactive participants 2022-01-01 46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 2
Total participants 2022-01-01 48
Number of participants with account balances 2022-01-01 47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 58
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 38
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 10
Total of all active and inactive participants 2021-01-01 48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 2
Total participants 2021-01-01 50
Number of participants with account balances 2021-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 58
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 50
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 6
Total of all active and inactive participants 2020-01-01 56
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 2
Total participants 2020-01-01 58
Number of participants with account balances 2020-01-01 55
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 65
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 52
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 4
Total of all active and inactive participants 2019-01-01 56
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 2
Total participants 2019-01-01 58
Number of participants with account balances 2019-01-01 57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 65
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 56
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 7
Total of all active and inactive participants 2018-01-01 63
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 2
Total participants 2018-01-01 65
Number of participants with account balances 2018-01-01 64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0

Measure	Date	Value
2022: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	50
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	36
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	10
Total of all active and inactive participants	2022-01-01	46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	2
Total participants	2022-01-01	48
Number of participants with account balances	2022-01-01	47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	58
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	38
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	10
Total of all active and inactive participants	2021-01-01	48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	2
Total participants	2021-01-01	50
Number of participants with account balances	2021-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	58
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	50
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	6
Total of all active and inactive participants	2020-01-01	56
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	2
Total participants	2020-01-01	58
Number of participants with account balances	2020-01-01	55
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	65
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	52
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	4
Total of all active and inactive participants	2019-01-01	56
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	2
Total participants	2019-01-01	58
Number of participants with account balances	2019-01-01	57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	65
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	56
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	7
Total of all active and inactive participants	2018-01-01	63
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	2
Total participants	2018-01-01	65
Number of participants with account balances	2018-01-01	64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0

Financial Data on AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN

Measure	Date	Value
2022 : AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2022 401k financial data
Total income from all sources	2022-12-31	$-3,012,739
Expenses. Total of all expenses incurred	2022-12-31	$1,087,141
Benefits paid (including direct rollovers)	2022-12-31	$1,073,880
Total plan assets at end of year	2022-12-31	$17,172,693
Total plan assets at beginning of year	2022-12-31	$21,272,573
Value of fidelity bond covering the plan	2022-12-31	$10,000,000
Other income received	2022-12-31	$-3,359,297
Net income (gross income less expenses)	2022-12-31	$-4,099,880
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$17,172,693
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$21,272,573
Assets. Value of participant loans	2022-12-31	$53,607
Total contributions received or receivable from employer(s)	2022-12-31	$346,558
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$13,261
2021 : AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2021 401k financial data
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$2,651,426
Expenses. Total of all expenses incurred	2021-12-31	$1,046,786
Benefits paid (including direct rollovers)	2021-12-31	$1,032,465
Total plan assets at end of year	2021-12-31	$21,272,573
Total plan assets at beginning of year	2021-12-31	$19,667,933
Value of fidelity bond covering the plan	2021-12-31	$10,000,000
Total contributions received or receivable from participants	2021-12-31	$532
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$2,256,376
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$1,604,640
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$21,272,573
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$19,667,933
Assets. Value of participant loans	2021-12-31	$93,964
Total contributions received or receivable from employer(s)	2021-12-31	$394,518
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$14,321
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2021-12-31	$0
Minimum employer required contribution for this plan year	2021-12-31	$394,518
Amount contributed by the employer to the plan for this plan year	2021-12-31	$394,518
2020 : AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2020 401k financial data
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$1,040,958
Expenses. Total of all expenses incurred	2020-12-31	$320,917
Benefits paid (including direct rollovers)	2020-12-31	$315,780
Total plan assets at end of year	2020-12-31	$19,667,933
Total plan assets at beginning of year	2020-12-31	$18,947,892
Value of fidelity bond covering the plan	2020-12-31	$10,000,000
Total contributions received or receivable from participants	2020-12-31	$0
Expenses. Other expenses not covered elsewhere	2020-12-31	$1,638
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$592,653
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$720,041
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$19,667,933
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$18,947,892
Assets. Value of participant loans	2020-12-31	$148,256
Total contributions received or receivable from employer(s)	2020-12-31	$448,305
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$3,499
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2020-12-31	$0
Minimum employer required contribution for this plan year	2020-12-31	$448,305
Amount contributed by the employer to the plan for this plan year	2020-12-31	$448,305
2019 : AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$3,750,224
Expenses. Total of all expenses incurred	2019-12-31	$1,802,694
Benefits paid (including direct rollovers)	2019-12-31	$1,795,840
Total plan assets at end of year	2019-12-31	$18,947,892
Total plan assets at beginning of year	2019-12-31	$17,000,362
Value of fidelity bond covering the plan	2019-12-31	$10,000,000
Total contributions received or receivable from participants	2019-12-31	$0
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$3,267,576
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$1,947,530
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$18,947,892
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$17,000,362
Assets. Value of participant loans	2019-12-31	$179,829
Total contributions received or receivable from employer(s)	2019-12-31	$482,648
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$6,854
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2019-12-31	$0
Minimum employer required contribution for this plan year	2019-12-31	$482,648
Amount contributed by the employer to the plan for this plan year	2019-12-31	$482,648
2018 : AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2018 401k financial data
Transfers to/from the plan	2018-12-31	$0
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$0
Total income from all sources	2018-12-31	$-342,585
Expenses. Total of all expenses incurred	2018-12-31	$420,534
Benefits paid (including direct rollovers)	2018-12-31	$411,832
Total plan assets at end of year	2018-12-31	$17,000,362
Total plan assets at beginning of year	2018-12-31	$17,763,481
Value of fidelity bond covering the plan	2018-12-31	$10,000,000
Total contributions received or receivable from participants	2018-12-31	$0
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$-855,223
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$-763,119
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$17,000,362
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$17,763,481
Assets. Value of participant loans	2018-12-31	$243,566
Total contributions received or receivable from employer(s)	2018-12-31	$512,638
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$8,702
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2018-12-31	$0
Minimum employer required contribution for this plan year	2018-12-31	$512,638
Amount contributed by the employer to the plan for this plan year	2018-12-31	$512,638

Form 5500 Responses for AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN

2022: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: AMERICAN MEDICAL RESPONSE HAWAII MONEY PURCHASE PENSION PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

SGIC 21126

Policy instance

Insurance contract or identification number	SGIC 21126
Number of Individuals Covered	17
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Other information about contract	GROUP ANNUITY CONTRACT

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

SGIC 21126

Policy instance

Insurance contract or identification number	SGIC 21126
Number of Individuals Covered	18
Insurance policy start date	2021-03-30
Insurance policy end date	2021-12-31
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?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Other information about contract	GROUP ANNUITY CONTRACT

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

SGIC 21126

Policy instance

Insurance contract or identification number	SGIC 21126
Number of Individuals Covered	20
Insurance policy start date	2020-03-30
Insurance policy end date	2020-12-31
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?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Other information about contract	GROUP ANNUITY CONTRACT

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

SAGIC 021103

Policy instance

Insurance contract or identification number	SAGIC 021103
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-04-01
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?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Other information about contract	GROUP ANNUITY

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

SAGIC 021103

Policy instance

Insurance contract or identification number	SAGIC 021103
Number of Individuals Covered	10
Insurance policy start date	2019-09-01
Insurance policy end date	2019-12-31
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?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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
Other information about contract	GROUP ANNUITY

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Company Name:	AMR HOLDCO, INC.
Employer identification number (EIN):	202076468
NAIC Classification:	621900