401k Plan data: ADAPT OF AMERICA, INC. RETIREMENT PLAN plan

ADAPT OF AMERICA, INC. RETIREMENT PLAN 401k Plan overview

Plan Name	ADAPT OF AMERICA, INC. RETIREMENT PLAN
Plan identification number	001

ADAPT OF AMERICA, INC. RETIREMENT PLAN Benefits

401k Plan Type

Defined 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 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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) received services of leased employees, as defined in Code section 414(n), during the plan year.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ADAPT OF AMERICA, INC. has sponsored the creation of one or more 401k plans.

Company Name: ADAPT OF AMERICA, INC.

Employer identification number (EIN): 431439551

NAIC Classification: 621420
NAIC Description: Outpatient Mental Health and Substance Abuse Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ADAPT OF AMERICA, INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2012-01-01 SHARON HOFFMAN SHARON HOFFMAN 2012-12-18
001 2011-01-01 SHARON HOFFMAN SHARON HOFFMAN 2012-09-12
001 2009-01-01 SHARON HOFFMAN SHARON HOFFMAN 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2012-01-01	SHARON HOFFMAN	SHARON HOFFMAN	2012-12-18
001	2011-01-01	SHARON HOFFMAN	SHARON HOFFMAN	2012-09-12
001	2009-01-01	SHARON HOFFMAN	SHARON HOFFMAN	2010-10-14

Plan Statistics for ADAPT OF AMERICA, INC. RETIREMENT PLAN

401k plan membership statisitcs for ADAPT OF AMERICA, INC. RETIREMENT PLAN

Measure Date Value
2022: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 205
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 89
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 48
Total of all active and inactive participants 2022-01-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 137
Number of participants with account balances 2022-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 215
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 158
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 47
Total of all active and inactive participants 2021-01-01 205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 205
Number of participants with account balances 2021-01-01 122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 208
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 164
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 46
Total of all active and inactive participants 2020-01-01 210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 210
Number of participants with account balances 2020-01-01 125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 249
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 158
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 49
Total of all active and inactive participants 2019-01-01 207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 207
Number of participants with account balances 2019-01-01 119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 283
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 204
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 38
Total of all active and inactive participants 2018-01-01 242
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 242
Number of participants with account balances 2018-01-01 142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2012: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 210
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 0
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 283
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 195
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 21
Total of all active and inactive participants 2011-01-01 216
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 216
Number of participants with account balances 2011-01-01 208
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 38
2009: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 215
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 203
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 81
Total of all active and inactive participants 2009-01-01 284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 284
Number of participants with account balances 2009-01-01 222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 45

Measure	Date	Value
2022: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	205
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	89
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	48
Total of all active and inactive participants	2022-01-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	137
Number of participants with account balances	2022-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	215
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	158
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	47
Total of all active and inactive participants	2021-01-01	205
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	205
Number of participants with account balances	2021-01-01	122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	208
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	164
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	46
Total of all active and inactive participants	2020-01-01	210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	210
Number of participants with account balances	2020-01-01	125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	249
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	158
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	49
Total of all active and inactive participants	2019-01-01	207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	207
Number of participants with account balances	2019-01-01	119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	283
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	204
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	38
Total of all active and inactive participants	2018-01-01	242
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	242
Number of participants with account balances	2018-01-01	142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2012: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	210
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	0
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	283
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	195
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	21
Total of all active and inactive participants	2011-01-01	216
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	216
Number of participants with account balances	2011-01-01	208
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	38
2009: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	215
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	203
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	81
Total of all active and inactive participants	2009-01-01	284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	284
Number of participants with account balances	2009-01-01	222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	45

Financial Data on ADAPT OF AMERICA, INC. RETIREMENT PLAN

Measure	Date	Value
2022 : ADAPT OF AMERICA, INC. RETIREMENT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$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	$-1,024,127
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$1,901,366
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,850,962
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$405,522
Value of total assets at end of year	2022-12-31	$6,451,567
Value of total assets at beginning of year	2022-12-31	$9,377,060
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$50,404
Total interest from all sources	2022-12-31	$4,894
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$118,782
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$118,782
Administrative expenses professional fees incurred	2022-12-31	$10,999
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$275,511
Participant contributions at end of year	2022-12-31	$35,255
Participant contributions at beginning of year	2022-12-31	$55,306
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-12-31	$193
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-2,925,493
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$6,451,567
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$9,377,060
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$6,047,432
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$9,164,242
Value of interest in pooled separate accounts at end of year	2022-12-31	$73,870
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$93,399
Interest on participant loans	2022-12-31	$1,971
Interest earned on other investments	2022-12-31	$2,923
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$295,010
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$62,360
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,538,285
Net investment gain/loss from pooled separate accounts	2022-12-31	$-15,040
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$130,011
Employer contributions (assets) at beginning of year	2022-12-31	$1,753
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$1,850,769
Contract administrator fees	2022-12-31	$39,405
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	RUBINBROWN LLP
Accountancy firm EIN	2022-12-31	430765316
2021 : ADAPT OF AMERICA, INC. RETIREMENT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$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	$1,660,848
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$1,211,164
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$1,149,994
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$575,898
Value of total assets at end of year	2021-12-31	$9,377,060
Value of total assets at beginning of year	2021-12-31	$8,927,376
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$61,170
Total interest from all sources	2021-12-31	$9,191
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$153,822
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$153,822
Administrative expenses professional fees incurred	2021-12-31	$11,791
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$400,094
Participant contributions at end of year	2021-12-31	$55,306
Participant contributions at beginning of year	2021-12-31	$115,983
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$13,336
Other income not declared elsewhere	2021-12-31	$20
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$449,684
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$9,377,060
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$8,927,376
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$9,164,242
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$8,470,818
Value of interest in pooled separate accounts at end of year	2021-12-31	$93,399
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$86,664
Interest on participant loans	2021-12-31	$4,656
Interest earned on other investments	2021-12-31	$4,535
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$62,360
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$253,911
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$901,579
Net investment gain/loss from pooled separate accounts	2021-12-31	$20,338
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$162,468
Employer contributions (assets) at end of year	2021-12-31	$1,753
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$1,149,994
Contract administrator fees	2021-12-31	$49,379
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	RUBINBROWN LLP
Accountancy firm EIN	2021-12-31	430765316
2020 : ADAPT OF AMERICA, INC. RETIREMENT PLAN 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets	2020-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2020-12-31	$0
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total transfer of assets to this plan	2020-12-31	$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	$1,791,942
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$1,615,120
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$1,561,056
Expenses. Certain deemed distributions of participant loans	2020-12-31	$0
Value of total corrective distributions	2020-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$523,790
Value of total assets at end of year	2020-12-31	$8,927,376
Value of total assets at beginning of year	2020-12-31	$8,750,554
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$54,064
Total income from rents	2020-12-31	$0
Total interest from all sources	2020-12-31	$10,696
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$259,572
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$259,572
Administrative expenses professional fees incurred	2020-12-31	$7,755
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Amount of non-exempt transactions with any party-in-interest	2020-12-31	$0
Contributions received from participants	2020-12-31	$354,082
Participant contributions at end of year	2020-12-31	$115,983
Participant contributions at beginning of year	2020-12-31	$127,762
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$16,818
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2020-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$0
Other income not declared elsewhere	2020-12-31	$3
Administrative expenses (other) incurred	2020-12-31	$0
Liabilities. Value of operating payables at beginning of year	2020-12-31	$0
Total non interest bearing cash at end of year	2020-12-31	$0
Total non interest bearing cash at beginning of year	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$176,822
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$8,927,376
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$8,750,554
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2020-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2020-12-31	$0
Investment advisory and management fees	2020-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$8,470,818
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$8,323,467
Value of interest in pooled separate accounts at end of year	2020-12-31	$86,664
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$94,446
Interest on participant loans	2020-12-31	$6,416
Income. Interest from loans (other than to participants)	2020-12-31	$0
Interest earned on other investments	2020-12-31	$4,280
Income. Interest from US Government securities	2020-12-31	$0
Income. Interest from corporate debt instruments	2020-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$253,911
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$204,879
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$995,991
Net investment gain/loss from pooled separate accounts	2020-12-31	$1,890
Net investment gain or loss from common/collective trusts	2020-12-31	$0
Net gain/loss from 103.12 investment entities	2020-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$152,890
Employer contributions (assets) at end of year	2020-12-31	$0
Employer contributions (assets) at beginning of year	2020-12-31	$0
Income. Dividends from preferred stock	2020-12-31	$0
Income. Dividends from common stock	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$1,561,056
Contract administrator fees	2020-12-31	$46,309
Liabilities. Value of benefit claims payable at beginning of year	2020-12-31	$0
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Aggregate proceeds on sale of assets	2020-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2020-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2020-12-31	$0
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	RUBINBROWN LLP
Accountancy firm EIN	2020-12-31	430765316
2019 : ADAPT OF AMERICA, INC. RETIREMENT PLAN 2019 401k financial data
Unrealized appreciation/depreciation of real estate assets	2019-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total transfer of assets to this plan	2019-12-31	$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	$2,346,970
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$2,280,506
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$2,223,472
Expenses. Certain deemed distributions of participant loans	2019-12-31	$0
Value of total corrective distributions	2019-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$627,411
Value of total assets at end of year	2019-12-31	$8,750,554
Value of total assets at beginning of year	2019-12-31	$8,684,090
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$57,034
Total income from rents	2019-12-31	$0
Total interest from all sources	2019-12-31	$8,960
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$182,158
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$182,158
Administrative expenses professional fees incurred	2019-12-31	$7,192
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Amount of non-exempt transactions with any party-in-interest	2019-12-31	$0
Contributions received from participants	2019-12-31	$432,181
Participant contributions at end of year	2019-12-31	$127,762
Participant contributions at beginning of year	2019-12-31	$160,808
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$0
Other income not declared elsewhere	2019-12-31	$0
Administrative expenses (other) incurred	2019-12-31	$0
Liabilities. Value of operating payables at beginning of year	2019-12-31	$0
Total non interest bearing cash at end of year	2019-12-31	$0
Total non interest bearing cash at beginning of year	2019-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$66,464
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$8,750,554
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$8,684,090
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2019-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2019-12-31	$0
Investment advisory and management fees	2019-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$8,323,467
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$8,402,671
Value of interest in pooled separate accounts at end of year	2019-12-31	$94,446
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$110,198
Interest on participant loans	2019-12-31	$7,017
Income. Interest from loans (other than to participants)	2019-12-31	$0
Interest earned on other investments	2019-12-31	$1,943
Income. Interest from US Government securities	2019-12-31	$0
Income. Interest from corporate debt instruments	2019-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$204,879
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$10,413
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$1,506,695
Net investment gain/loss from pooled separate accounts	2019-12-31	$21,746
Net investment gain or loss from common/collective trusts	2019-12-31	$0
Net gain/loss from 103.12 investment entities	2019-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$195,230
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$0
Income. Dividends from preferred stock	2019-12-31	$0
Income. Dividends from common stock	2019-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$2,223,472
Contract administrator fees	2019-12-31	$49,842
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$0
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Aggregate proceeds on sale of assets	2019-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2019-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2019-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	RUBINBROWN LLP
Accountancy firm EIN	2019-12-31	430765316
2018 : ADAPT OF AMERICA, INC. RETIREMENT PLAN 2018 401k financial data
Unrealized appreciation/depreciation of real estate assets	2018-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2018-12-31	$0
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total transfer of assets to this plan	2018-12-31	$8,833,798
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	$97,962
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$247,670
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$201,989
Expenses. Certain deemed distributions of participant loans	2018-12-31	$0
Value of total corrective distributions	2018-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$601,688
Value of total assets at end of year	2018-12-31	$8,684,090
Value of total assets at beginning of year	2018-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$45,681
Total income from rents	2018-12-31	$0
Total interest from all sources	2018-12-31	$7,914
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$286,527
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$286,527
Administrative expenses professional fees incurred	2018-12-31	$0
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Amount of non-exempt transactions with any party-in-interest	2018-12-31	$0
Contributions received from participants	2018-12-31	$407,705
Participant contributions at end of year	2018-12-31	$160,808
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2018-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$0
Other income not declared elsewhere	2018-12-31	$0
Administrative expenses (other) incurred	2018-12-31	$0
Liabilities. Value of operating payables at beginning of year	2018-12-31	$0
Total non interest bearing cash at end of year	2018-12-31	$0
Total non interest bearing cash at beginning of year	2018-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-149,708
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$8,684,090
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2018-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2018-12-31	$0
Investment advisory and management fees	2018-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$8,402,671
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$0
Value of interest in pooled separate accounts at end of year	2018-12-31	$110,198
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$0
Interest on participant loans	2018-12-31	$7,914
Income. Interest from loans (other than to participants)	2018-12-31	$0
Interest earned on other investments	2018-12-31	$0
Income. Interest from US Government securities	2018-12-31	$0
Income. Interest from corporate debt instruments	2018-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$10,413
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-784,531
Net investment gain/loss from pooled separate accounts	2018-12-31	$-13,636
Net investment gain or loss from common/collective trusts	2018-12-31	$0
Net gain/loss from 103.12 investment entities	2018-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$193,983
Employer contributions (assets) at end of year	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$0
Income. Dividends from preferred stock	2018-12-31	$0
Income. Dividends from common stock	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$201,989
Contract administrator fees	2018-12-31	$45,681
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	Yes
Liabilities. Value of benefit claims payable at beginning of year	2018-12-31	$0
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Aggregate proceeds on sale of assets	2018-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2018-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2018-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	RUBIN BROWN LLP
Accountancy firm EIN	2018-12-31	430765316
2012 : ADAPT OF AMERICA, INC. RETIREMENT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets	2012-02-29	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2012-02-29	$0
Total unrealized appreciation/depreciation of assets	2012-02-29	$0
Total transfer of assets to this plan	2012-02-29	$0
Total transfer of assets from this plan	2012-02-29	$4,323,040
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-02-29	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-02-29	$0
Total income from all sources (including contributions)	2012-02-29	$289,372
Total loss/gain on sale of assets	2012-02-29	$0
Total of all expenses incurred	2012-02-29	$192,053
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-02-29	$191,766
Expenses. Certain deemed distributions of participant loans	2012-02-29	$0
Value of total corrective distributions	2012-02-29	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-02-29	$0
Value of total assets at end of year	2012-02-29	$0
Value of total assets at beginning of year	2012-02-29	$4,225,721
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-02-29	$287
Total income from rents	2012-02-29	$0
Total interest from all sources	2012-02-29	$787
Total dividends received (eg from common stock, registered investment company shares)	2012-02-29	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-02-29	Yes
Total dividends received from registered investment company shares (eg mutual funds)	2012-02-29	$0
Administrative expenses professional fees incurred	2012-02-29	$0
Was this plan covered by a fidelity bond	2012-02-29	Yes
Value of fidelity bond cover	2012-02-29	$300,000
If this is an individual account plan, was there a blackout period	2012-02-29	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-02-29	$0
Were there any nonexempt tranactions with any party-in-interest	2012-02-29	No
Amount of non-exempt transactions with any party-in-interest	2012-02-29	$0
Contributions received from participants	2012-02-29	$0
Participant contributions at end of year	2012-02-29	$0
Participant contributions at beginning of year	2012-02-29	$87,029
Participant contributions at end of year	2012-02-29	$0
Participant contributions at beginning of year	2012-02-29	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-02-29	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-02-29	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-02-29	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-02-29	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-02-29	$0
Other income not declared elsewhere	2012-02-29	$0
Administrative expenses (other) incurred	2012-02-29	$0
Liabilities. Value of operating payables at beginning of year	2012-02-29	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-02-29	No
Value of net income/loss	2012-02-29	$97,319
Value of net assets at end of year (total assets less liabilities)	2012-02-29	$0
Value of net assets at beginning of year (total assets less liabilities)	2012-02-29	$4,225,721
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-02-29	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-02-29	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2012-02-29	$0
Were any leases to which the plan was party in default or uncollectible	2012-02-29	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2012-02-29	$0
Investment advisory and management fees	2012-02-29	$0
Value of interest in pooled separate accounts at end of year	2012-02-29	$0
Value of interest in pooled separate accounts at beginning of year	2012-02-29	$4,033,891
Interest on participant loans	2012-02-29	$399
Income. Interest from loans (other than to participants)	2012-02-29	$0
Interest earned on other investments	2012-02-29	$388
Income. Interest from US Government securities	2012-02-29	$0
Income. Interest from corporate debt instruments	2012-02-29	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-02-29	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-02-29	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-02-29	$104,801
Expenses. Payments to insurance carriers foe the provision of benefits	2012-02-29	$77,365
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-02-29	$0
Net investment gain/loss from pooled separate accounts	2012-02-29	$288,585
Net investment gain or loss from common/collective trusts	2012-02-29	$0
Net gain/loss from 103.12 investment entities	2012-02-29	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-02-29	No
Was there a failure to transmit to the plan any participant contributions	2012-02-29	Yes
Has the plan failed to provide any benefit when due under the plan	2012-02-29	No
Contributions received in cash from employer	2012-02-29	$0
Employer contributions (assets) at end of year	2012-02-29	$0
Employer contributions (assets) at beginning of year	2012-02-29	$0
Income. Dividends from preferred stock	2012-02-29	$0
Income. Dividends from common stock	2012-02-29	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-02-29	$114,401
Contract administrator fees	2012-02-29	$287
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-02-29	Yes
Liabilities. Value of benefit claims payable at beginning of year	2012-02-29	$0
Did the plan have assets held for investment	2012-02-29	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-02-29	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-02-29	Yes
Aggregate proceeds on sale of assets	2012-02-29	$0
Aggregate carrying amount (costs) on sale of assets	2012-02-29	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2012-02-29	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-02-29	Yes
Opinion of an independent qualified public accountant for this plan	2012-02-29	Disclaimer
Accountancy firm name	2012-02-29	STONE CARLIE & COMPANY, LLC
Accountancy firm EIN	2012-02-29	430642511
2011 : ADAPT OF AMERICA, INC. RETIREMENT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets	2011-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$0
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$0
Total transfer of assets from this plan	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$633,476
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$447,520
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$445,806
Expenses. Certain deemed distributions of participant loans	2011-12-31	$0
Value of total corrective distributions	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$623,025
Value of total assets at end of year	2011-12-31	$4,225,721
Value of total assets at beginning of year	2011-12-31	$4,039,765
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,714
Total income from rents	2011-12-31	$0
Total interest from all sources	2011-12-31	$7,884
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$0
Administrative expenses professional fees incurred	2011-12-31	$0
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$300,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Amount of non-exempt transactions with any party-in-interest	2011-12-31	$0
Contributions received from participants	2011-12-31	$370,960
Participant contributions at end of year	2011-12-31	$87,029
Participant contributions at beginning of year	2011-12-31	$97,500
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$2,469
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$0
Liabilities. Value of operating payables at beginning of year	2011-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$185,956
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$4,225,721
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$4,039,765
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2011-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2011-12-31	$0
Investment advisory and management fees	2011-12-31	$0
Value of interest in pooled separate accounts at end of year	2011-12-31	$4,033,891
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$3,807,172
Interest on participant loans	2011-12-31	$4,414
Income. Interest from loans (other than to participants)	2011-12-31	$0
Interest earned on other investments	2011-12-31	$3,470
Income. Interest from US Government securities	2011-12-31	$0
Income. Interest from corporate debt instruments	2011-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$104,801
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$135,093
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$0
Net investment gain/loss from pooled separate accounts	2011-12-31	$2,567
Net investment gain or loss from common/collective trusts	2011-12-31	$0
Net gain/loss from 103.12 investment entities	2011-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$252,065
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$0
Income. Dividends from preferred stock	2011-12-31	$0
Income. Dividends from common stock	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$443,337
Contract administrator fees	2011-12-31	$1,714
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$0
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Aggregate proceeds on sale of assets	2011-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2011-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	STONE CARLIE & COMPANY, LLC
Accountancy firm EIN	2011-12-31	430642511
2010 : ADAPT OF AMERICA, INC. RETIREMENT PLAN 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets	2010-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$0
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total transfer of assets to this plan	2010-12-31	$0
Total transfer of assets from this plan	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$1,114,900
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$276,094
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$274,186
Expenses. Certain deemed distributions of participant loans	2010-12-31	$0
Value of total corrective distributions	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$628,361
Value of total assets at end of year	2010-12-31	$4,039,765
Value of total assets at beginning of year	2010-12-31	$3,200,959
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,908
Total income from rents	2010-12-31	$0
Total interest from all sources	2010-12-31	$10,944
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$0
Administrative expenses professional fees incurred	2010-12-31	$0
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$100,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Amount of non-exempt transactions with any party-in-interest	2010-12-31	$0
Contributions received from participants	2010-12-31	$369,007
Participant contributions at end of year	2010-12-31	$97,500
Participant contributions at beginning of year	2010-12-31	$98,983
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$3,122
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$1,033
Administrative expenses (other) incurred	2010-12-31	$0
Liabilities. Value of operating payables at beginning of year	2010-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$838,806
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$4,039,765
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$3,200,959
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year	2010-12-31	$0
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year	2010-12-31	$0
Investment advisory and management fees	2010-12-31	$0
Value of interest in pooled separate accounts at end of year	2010-12-31	$3,807,172
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$2,941,435
Interest on participant loans	2010-12-31	$6,223
Income. Interest from loans (other than to participants)	2010-12-31	$0
Interest earned on other investments	2010-12-31	$4,721
Income. Interest from US Government securities	2010-12-31	$0
Income. Interest from corporate debt instruments	2010-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$135,093
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$160,541
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$0
Net investment gain/loss from pooled separate accounts	2010-12-31	$474,562
Net investment gain or loss from common/collective trusts	2010-12-31	$0
Net gain/loss from 103.12 investment entities	2010-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$256,232
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$0
Income. Dividends from preferred stock	2010-12-31	$0
Income. Dividends from common stock	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$274,186
Contract administrator fees	2010-12-31	$1,908
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$0
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Aggregate proceeds on sale of assets	2010-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2010-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	STONE CARLIE & COMPANY, LLC
Accountancy firm EIN	2010-12-31	430642511
2009 : ADAPT OF AMERICA, INC. RETIREMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for ADAPT OF AMERICA, INC. RETIREMENT PLAN

2022: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
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	No
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: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
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	No
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: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
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	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
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	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: ADAPT OF AMERICA, INC. RETIREMENT 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	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	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2012: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	This submission is the final filing	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: ADAPT OF AMERICA, INC. RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

466283

Policy instance

Insurance contract or identification number	466283
Number of Individuals Covered	137
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	137
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

466283

Policy instance

Insurance contract or identification number	466283
Number of Individuals Covered	205
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	205
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

466283

Policy instance

Insurance contract or identification number	466283
Number of Individuals Covered	210
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	210
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

466283

Policy instance

Insurance contract or identification number	466283
Number of Individuals Covered	207
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	207
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

466283

Policy instance

Insurance contract or identification number	466283
Number of Individuals Covered	242
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	242
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

ADAPT OF THE HUDSON VALLEY WRAP PLAN [EIN = 862864372]

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Company Name:	ADAPT OF AMERICA, INC.
Employer identification number (EIN):	431439551
NAIC Classification:	621420
NAIC Description:	Outpatient Mental Health and Substance Abuse Centers