401k Plan data: MHSA 403B PLAN plan

MHSA 403B PLAN 401k Plan overview

Plan Name	MHSA 403B PLAN
Plan identification number	001

MHSA 403B PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

MIDDLESEX HUMAN SERVICE AGENCY INC. has sponsored the creation of one or more 401k plans.

Company Name: MIDDLESEX HUMAN SERVICE AGENCY INC.

Employer identification number (EIN): 042626387

NAIC Classification: 446190

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MHSA 403B PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-07-01 G PETER DONOVAN 2014-04-09 G PETER DONOVAN 2014-04-09
001 2011-07-01 G PETER DONOVAN G PETER DONOVAN 2013-04-15
001 2010-07-01 G PETER DONOVAN
001 2009-07-01 DORIS C MEDEIROS DORIS C MEDEIROS 2011-04-15
001 2009-07-01 DORIS C MEDEIROS DORIS C MEDEIROS 2011-04-15
001 2009-07-01 DORIS C MEDEIROS DORIS C MEDEIROS 2011-04-15
001 2009-07-01 DORIS MEDEIROS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2012-07-01	G PETER DONOVAN	2014-04-09	G PETER DONOVAN	2014-04-09
001	2011-07-01	G PETER DONOVAN		G PETER DONOVAN	2013-04-15
001	2010-07-01	G PETER DONOVAN
001	2009-07-01	DORIS C MEDEIROS		DORIS C MEDEIROS	2011-04-15
001	2009-07-01	DORIS C MEDEIROS		DORIS C MEDEIROS	2011-04-15
001	2009-07-01	DORIS C MEDEIROS		DORIS C MEDEIROS	2011-04-15
001	2009-07-01	DORIS MEDEIROS

Plan Statistics for MHSA 403B PLAN

401k plan membership statisitcs for MHSA 403B PLAN

Measure Date Value
2011: MHSA 403B PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 119
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 16
Number of retired or separated participants receiving benefits 2011-07-01 0
Number of other retired or separated participants entitled to future benefits 2011-07-01 61
Total of all active and inactive participants 2011-07-01 77
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 77
Number of participants with account balances 2011-07-01 63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 0
2010: MHSA 403B PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 131
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 119
Number of retired or separated participants receiving benefits 2010-07-01 0
Number of other retired or separated participants entitled to future benefits 2010-07-01 1
Total of all active and inactive participants 2010-07-01 120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-07-01 0
Total participants 2010-07-01 120
Number of participants with account balances 2010-07-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-07-01 0
2009: MHSA 403B PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 161
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 123
Number of retired or separated participants receiving benefits 2009-07-01 0
Number of other retired or separated participants entitled to future benefits 2009-07-01 1
Total of all active and inactive participants 2009-07-01 124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-07-01 0
Total participants 2009-07-01 124
Number of participants with account balances 2009-07-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-07-01 0

Measure	Date	Value
2011: MHSA 403B PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	119
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	16
Number of retired or separated participants receiving benefits	2011-07-01	0
Number of other retired or separated participants entitled to future benefits	2011-07-01	61
Total of all active and inactive participants	2011-07-01	77
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	77
Number of participants with account balances	2011-07-01	63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	0
2010: MHSA 403B PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	131
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	119
Number of retired or separated participants receiving benefits	2010-07-01	0
Number of other retired or separated participants entitled to future benefits	2010-07-01	1
Total of all active and inactive participants	2010-07-01	120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-07-01	0
Total participants	2010-07-01	120
Number of participants with account balances	2010-07-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-07-01	0
2009: MHSA 403B PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	161
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	123
Number of retired or separated participants receiving benefits	2009-07-01	0
Number of other retired or separated participants entitled to future benefits	2009-07-01	1
Total of all active and inactive participants	2009-07-01	124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-07-01	0
Total participants	2009-07-01	124
Number of participants with account balances	2009-07-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-07-01	0

Financial Data on MHSA 403B PLAN

Measure	Date	Value
2012 : MHSA 403B PLAN 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets	2012-06-30	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2012-06-30	$0
Total unrealized appreciation/depreciation of assets	2012-06-30	$0
Total transfer of assets to this plan	2012-06-30	$0
Total transfer of assets from this plan	2012-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$0
Expenses. Interest paid	2012-06-30	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2012-06-30	$0
Total income from all sources (including contributions)	2012-06-30	$29,965
Total loss/gain on sale of assets	2012-06-30	$0
Total of all expenses incurred	2012-06-30	$810,706
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$808,532
Expenses. Certain deemed distributions of participant loans	2012-06-30	$0
Value of total corrective distributions	2012-06-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$14,867
Value of total assets at end of year	2012-06-30	$7,002
Value of total assets at beginning of year	2012-06-30	$787,743
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$2,174
Total income from rents	2012-06-30	$0
Total interest from all sources	2012-06-30	$6,394
Total dividends received (eg from common stock, registered investment company shares)	2012-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2012-06-30	$0
Total dividends received from registered investment company shares (eg mutual funds)	2012-06-30	$0
Assets. Real estate other than employer real property at end of year	2012-06-30	$0
Assets. Real estate other than employer real property at beginning of year	2012-06-30	$0
Administrative expenses professional fees incurred	2012-06-30	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2012-06-30	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2012-06-30	$0
Was this plan covered by a fidelity bond	2012-06-30	No
If this is an individual account plan, was there a blackout period	2012-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$14,867
Participant contributions at end of year	2012-06-30	$0
Participant contributions at beginning of year	2012-06-30	$0
Participant contributions at end of year	2012-06-30	$0
Participant contributions at beginning of year	2012-06-30	$0
Assets. Other investments not covered elsewhere at end of year	2012-06-30	$0
Assets. Other investments not covered elsewhere at beginning of year	2012-06-30	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-06-30	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-06-30	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-06-30	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-06-30	$0
Assets. Loans (other than to participants) at end of year	2012-06-30	$0
Assets. Loans (other than to participants) at beginning of year	2012-06-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-06-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-06-30	$0
Other income not declared elsewhere	2012-06-30	$0
Administrative expenses (other) incurred	2012-06-30	$2,174
Liabilities. Value of operating payables at end of year	2012-06-30	$0
Liabilities. Value of operating payables at beginning of year	2012-06-30	$0
Total non interest bearing cash at end of year	2012-06-30	$0
Total non interest bearing cash at beginning of year	2012-06-30	$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	2012-06-30	No
Income. Non cash contributions	2012-06-30	$0
Value of net income/loss	2012-06-30	$-780,741
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$7,002
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$787,743
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Assets. partnership/joint venture interests at end of year	2012-06-30	$0
Assets. partnership/joint venture interests at beginning of year	2012-06-30	$0
Investment advisory and management fees	2012-06-30	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-06-30	$7,002
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-06-30	$513,507
Value of interest in pooled separate accounts at end of year	2012-06-30	$0
Value of interest in pooled separate accounts at beginning of year	2012-06-30	$0
Interest on participant loans	2012-06-30	$0
Income. Interest from loans (other than to participants)	2012-06-30	$0
Interest earned on other investments	2012-06-30	$0
Income. Interest from US Government securities	2012-06-30	$0
Income. Interest from corporate debt instruments	2012-06-30	$0
Value of interest in master investment trust accounts at end of year	2012-06-30	$0
Value of interest in master investment trust accounts at beginning of year	2012-06-30	$0
Value of interest in common/collective trusts at end of year	2012-06-30	$0
Value of interest in common/collective trusts at beginning of year	2012-06-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-06-30	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-06-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-06-30	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-06-30	$6,394
Assets. Value of investments in 103.12 investment entities at end of year	2012-06-30	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2012-06-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-06-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-06-30	$274,236
Expenses. Payments to insurance carriers foe the provision of benefits	2012-06-30	$0
Asset value of US Government securities at end of year	2012-06-30	$0
Asset value of US Government securities at beginning of year	2012-06-30	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-06-30	$8,704
Net investment gain/loss from pooled separate accounts	2012-06-30	$0
Net investment gain or loss from common/collective trusts	2012-06-30	$0
Net gain/loss from 103.12 investment entities	2012-06-30	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	No
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Assets. Invements in employer securities at end of year	2012-06-30	$0
Assets. Invements in employer securities at beginning of year	2012-06-30	$0
Assets. Value of employer real property at end of year	2012-06-30	$0
Assets. Value of employer real property at beginning of year	2012-06-30	$0
Contributions received in cash from employer	2012-06-30	$0
Employer contributions (assets) at end of year	2012-06-30	$0
Employer contributions (assets) at beginning of year	2012-06-30	$0
Income. Dividends from preferred stock	2012-06-30	$0
Income. Dividends from common stock	2012-06-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$808,532
Asset. Corporate debt instrument preferred debt at end of year	2012-06-30	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2012-06-30	$0
Asset. Corporate debt instrument debt (other) at end of year	2012-06-30	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2012-06-30	$0
Contract administrator fees	2012-06-30	$0
Assets. Corporate common stocks other than exployer securities at end of year	2012-06-30	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-06-30	$0
Liabilities. Value of benefit claims payable at end of year	2012-06-30	$0
Liabilities. Value of benefit claims payable at beginning of year	2012-06-30	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2012-06-30	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2012-06-30	$0
Did the plan have assets held for investment	2012-06-30	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	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Aggregate proceeds on sale of assets	2012-06-30	$0
Aggregate carrying amount (costs) on sale of assets	2012-06-30	$0
Liabilities. Value of acquisition indebtedness at end of year	2012-06-30	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2012-06-30	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-06-30	Disclaimer
Accountancy firm name	2012-06-30	KATZ NANNIS AND SOLOMON P.C.
Accountancy firm EIN	2012-06-30	042887211
2011 : MHSA 403B PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$0
Total income from all sources (including contributions)	2011-06-30	$116,132
Total loss/gain on sale of assets	2011-06-30	$0
Total of all expenses incurred	2011-06-30	$757
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$0
Value of total corrective distributions	2011-06-30	$757
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$34,810
Value of total assets at end of year	2011-06-30	$787,743
Value of total assets at beginning of year	2011-06-30	$672,368
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$0
Total interest from all sources	2011-06-30	$8,883
Total dividends received (eg from common stock, registered investment company shares)	2011-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Was this plan covered by a fidelity bond	2011-06-30	No
If this is an individual account plan, was there a blackout period	2011-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Contributions received from participants	2011-06-30	$34,810
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Value of net income/loss	2011-06-30	$115,375
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$787,743
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$672,368
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-06-30	No
Were any leases to which the plan was party in default or uncollectible	2011-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-06-30	$513,507
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-06-30	$414,015
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-06-30	$8,883
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-06-30	$274,236
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-06-30	$258,353
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-06-30	$72,439
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-06-30	No
Was there a failure to transmit to the plan any participant contributions	2011-06-30	No
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Did the plan have assets held for investment	2011-06-30	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	2011-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-06-30	Disclaimer
Accountancy firm name	2011-06-30	KATZ,NANNIS & SOLOMON PC
Accountancy firm EIN	2011-06-30	042887211
2010 : MHSA 403B PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-06-30	$0

Form 5500 Responses for MHSA 403B PLAN

2011: MHSA 403B PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2010: MHSA 403B PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Submission has been amended	No
2010-07-01	This submission is the final filing	No
2010-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-07-01	Plan is a collectively bargained plan	No
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement - Trust	Yes
2009: MHSA 403B PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	Yes
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G75302

Policy instance

Insurance contract or identification number	G75302
Number of Individuals Covered	63
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $1,331
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?	Yes
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

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G75302

Policy instance

Insurance contract or identification number	G75302
Number of Individuals Covered	8
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $1,915
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?	Yes
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

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Company Name:	MIDDLESEX HUMAN SERVICE AGENCY INC.
Employer identification number (EIN):	042626387
NAIC Classification:	446190