401k Plan data: OHACS 401(K) PLAN plan

OHACS 401(K) PLAN 401k Plan overview

Plan Name	OHACS 401(K) PLAN
Plan identification number	001

OHACS 401(K) 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.
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.

401k Sponsoring company profile

UPSTATE COMMUNITY MEDICAL, PC has sponsored the creation of one or more 401k plans.

Company Name: UPSTATE COMMUNITY MEDICAL, PC

Employer identification number (EIN): 203889761

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OHACS 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 EDWARD MARRYOTT 2023-10-16 EDWARD MARRYOTT 2023-10-16
001 2021-01-01 NANCY DAOUST 2022-10-17 NANCY DAOUST 2022-10-17
001 2020-01-01
001 2019-01-01
001 2018-01-01 KIMBERLY SULLIVAN-DEC 2019-06-25 KIMBERLY SULLIVAN-DEC 2019-06-25
001 2017-01-01 KIMBERLY SULLIVAN-DEC 2018-09-27 KIMBERLY SULLIVAN-DEC 2018-09-27
001 2016-01-01 KIMBERLY SULLIVAN-DEC 2017-06-08 KIMBERLY SULLIVAN-DEC 2017-06-08
001 2015-01-01 BONNIE GROSSMAN 2016-08-19 BONNIE GROSSMAN 2016-08-19
001 2014-01-01 BONNIE GROSSMAN, M.D. 2015-10-05 BONNIE GROSSMAN, M.D. 2015-10-05
001 2013-01-01
001 2012-01-01 BONNIE GROSSMAN 2013-05-30
001 2011-01-01 DENNIS J. TERPANIER 2012-05-21
001 2010-01-01 DENNIS J. TERPANIER 2011-05-15 PERRY NATHANAIL 2011-05-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	EDWARD MARRYOTT	2023-10-16	EDWARD MARRYOTT	2023-10-16
001	2021-01-01	NANCY DAOUST	2022-10-17	NANCY DAOUST	2022-10-17
001	2020-01-01
001	2019-01-01
001	2018-01-01	KIMBERLY SULLIVAN-DEC	2019-06-25	KIMBERLY SULLIVAN-DEC	2019-06-25
001	2017-01-01	KIMBERLY SULLIVAN-DEC	2018-09-27	KIMBERLY SULLIVAN-DEC	2018-09-27
001	2016-01-01	KIMBERLY SULLIVAN-DEC	2017-06-08	KIMBERLY SULLIVAN-DEC	2017-06-08
001	2015-01-01	BONNIE GROSSMAN	2016-08-19	BONNIE GROSSMAN	2016-08-19
001	2014-01-01	BONNIE GROSSMAN, M.D.	2015-10-05	BONNIE GROSSMAN, M.D.	2015-10-05
001	2013-01-01
001	2012-01-01	BONNIE GROSSMAN	2013-05-30
001	2011-01-01	DENNIS J. TERPANIER	2012-05-21
001	2010-01-01	DENNIS J. TERPANIER	2011-05-15	PERRY NATHANAIL	2011-05-15

Plan Statistics for OHACS 401(K) PLAN

401k plan membership statisitcs for OHACS 401(K) PLAN

Measure Date Value
2022: OHACS 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 122
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 39
Total of all active and inactive participants 2022-01-01 161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 161
Number of participants with account balances 2022-01-01 116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: OHACS 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 146
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 121
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 31
Total of all active and inactive participants 2021-01-01 152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 152
Number of participants with account balances 2021-01-01 110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: OHACS 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 146
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 127
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 19
Total of all active and inactive participants 2020-01-01 146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 146
Number of participants with account balances 2020-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: OHACS 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 131
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 14
Total of all active and inactive participants 2019-01-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 145
Number of participants with account balances 2019-01-01 99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0

Measure	Date	Value
2022: OHACS 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	122
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	39
Total of all active and inactive participants	2022-01-01	161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	161
Number of participants with account balances	2022-01-01	116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: OHACS 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	146
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	121
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	31
Total of all active and inactive participants	2021-01-01	152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	152
Number of participants with account balances	2021-01-01	110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: OHACS 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	146
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	127
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	19
Total of all active and inactive participants	2020-01-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	146
Number of participants with account balances	2020-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: OHACS 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	131
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	14
Total of all active and inactive participants	2019-01-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	145
Number of participants with account balances	2019-01-01	99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0

Financial Data on OHACS 401(K) PLAN

Measure	Date	Value
2022 : OHACS 401(K) PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$1,100
Total income from all sources (including contributions)	2022-12-31	$-84,538
Total of all expenses incurred	2022-12-31	$725,737
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$680,563
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,491,121
Value of total assets at end of year	2022-12-31	$8,972,867
Value of total assets at beginning of year	2022-12-31	$9,782,042
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$45,174
Total interest from all sources	2022-12-31	$2,570
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$153,449
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	$153,449
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
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	$809,995
Participant contributions at end of year	2022-12-31	$33,576
Participant contributions at beginning of year	2022-12-31	$32,218
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$291,731
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-12-31	$1,113
Liabilities. Value of operating payables at end of year	2022-12-31	$1,100
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	$-810,275
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$8,971,767
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$9,782,042
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
Investment advisory and management fees	2022-12-31	$45,174
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$8,282,193
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$9,645,187
Interest on participant loans	2022-12-31	$2,570
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$606,726
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$60,403
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,731,678
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	$389,395
Employer contributions (assets) at end of year	2022-12-31	$50,372
Employer contributions (assets) at beginning of year	2022-12-31	$44,234
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$679,450
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	FUSTCHARLES LLP
Accountancy firm EIN	2022-12-31	161226221
2021 : OHACS 401(K) PLAN 2021 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$2,786,998
Total of all expenses incurred	2021-12-31	$669,475
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$623,237
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$1,353,797
Value of total assets at end of year	2021-12-31	$9,782,042
Value of total assets at beginning of year	2021-12-31	$7,664,519
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$46,238
Total interest from all sources	2021-12-31	$2,494
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$739,446
Participant contributions at end of year	2021-12-31	$32,218
Participant contributions at beginning of year	2021-12-31	$43,296
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$243,657
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	$2,117,523
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$9,782,042
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$7,664,519
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
Investment advisory and management fees	2021-12-31	$46,238
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$9,645,187
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$7,442,734
Interest on participant loans	2021-12-31	$2,494
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$60,403
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$150,080
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$1,430,707
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	$370,694
Employer contributions (assets) at end of year	2021-12-31	$44,234
Employer contributions (assets) at beginning of year	2021-12-31	$28,409
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$623,237
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
Liabilities. Value of acquisition indebtedness at beginning of year	2021-12-31	$0
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	FUST CHARLES CHAMBERS LLP
Accountancy firm EIN	2021-12-31	161226221
2020 : OHACS 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	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	$94
Total income from all sources (including contributions)	2020-12-31	$2,047,881
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$221,009
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$188,742
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,018,605
Value of total assets at end of year	2020-12-31	$7,664,519
Value of total assets at beginning of year	2020-12-31	$5,837,741
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$32,267
Total interest from all sources	2020-12-31	$5,068
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$678,891
Participant contributions at end of year	2020-12-31	$43,296
Participant contributions at beginning of year	2020-12-31	$62,166
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$93
Administrative expenses (other) incurred	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	$1,826,872
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$7,664,519
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$5,837,647
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
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$32,267
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$7,442,734
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$5,620,153
Interest on participant loans	2020-12-31	$3,502
Value of interest in common/collective trusts at beginning of year	2020-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$1,566
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$150,080
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$126,780
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$1,024,208
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	No
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	$339,621
Employer contributions (assets) at end of year	2020-12-31	$28,409
Employer contributions (assets) at beginning of year	2020-12-31	$28,642
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$188,742
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
Liabilities. Value of acquisition indebtedness at end of year	2020-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2020-12-31	$94
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	FUST CHARLES CHAMBERS LLP
Accountancy firm EIN	2020-12-31	161226221
2019 : OHACS 401(K) PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$94
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$94
Total income from all sources (including contributions)	2019-12-31	$2,060,884
Total income from all sources (including contributions)	2019-12-31	$2,060,884
Total of all expenses incurred	2019-12-31	$87,134
Total of all expenses incurred	2019-12-31	$87,134
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$61,256
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$61,256
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,038,135
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,038,135
Value of total assets at end of year	2019-12-31	$5,837,741
Value of total assets at end of year	2019-12-31	$5,837,741
Value of total assets at beginning of year	2019-12-31	$3,863,897
Value of total assets at beginning of year	2019-12-31	$3,863,897
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$25,878
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$25,878
Total interest from all sources	2019-12-31	$5,526
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$697,492
Contributions received from participants	2019-12-31	$697,492
Participant contributions at end of year	2019-12-31	$62,166
Participant contributions at end of year	2019-12-31	$62,166
Participant contributions at beginning of year	2019-12-31	$67,672
Participant contributions at beginning of year	2019-12-31	$67,672
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$5,580
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$5,580
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
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	$1,973,750
Value of net income/loss	2019-12-31	$1,973,750
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$5,837,647
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$5,837,647
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,863,897
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,863,897
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
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
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$25,878
Investment advisory and management fees	2019-12-31	$25,878
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$5,620,153
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$5,620,153
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,704,808
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$3,704,808
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$0
Interest on participant loans	2019-12-31	$4,336
Interest on participant loans	2019-12-31	$4,336
Value of interest in common/collective trusts at end of year	2019-12-31	$0
Value of interest in common/collective trusts at end of year	2019-12-31	$0
Value of interest in common/collective trusts at beginning of year	2019-12-31	$0
Value of interest in common/collective trusts at beginning of year	2019-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$1,190
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$1,190
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$126,780
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$126,780
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$66,598
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$66,598
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$1,017,223
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$1,017,223
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
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	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
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	$335,063
Contributions received in cash from employer	2019-12-31	$335,063
Employer contributions (assets) at end of year	2019-12-31	$28,642
Employer contributions (assets) at end of year	2019-12-31	$28,642
Employer contributions (assets) at beginning of year	2019-12-31	$24,819
Employer contributions (assets) at beginning of year	2019-12-31	$24,819
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$61,256
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$61,256
Did the plan have assets held for investment	2019-12-31	Yes
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
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
Liabilities. Value of acquisition indebtedness at end of year	2019-12-31	$94
Liabilities. Value of acquisition indebtedness at end of year	2019-12-31	$94
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
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
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	FUST CHARLES CHAMBERS LLP
Accountancy firm name	2019-12-31	FUST CHARLES CHAMBERS LLP
Accountancy firm EIN	2019-12-31	161226221
Accountancy firm EIN	2019-12-31	161226221

Form 5500 Responses for OHACS 401(K) PLAN

2022: OHACS 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	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: OHACS 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	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: OHACS 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	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: OHACS 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	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

Insurance Providers Used on plan

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

517368-000

Policy instance

Insurance contract or identification number	517368-000
Number of Individuals Covered	116
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 $4,316
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
Amount paid for insurance broker fees	4316
Insurance broker organization code?	5

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

517368-000

Policy instance

Insurance contract or identification number	517368-000
Number of Individuals Covered	110
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
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
Insurance broker organization code?	5

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

517368-000

Policy instance

Insurance contract or identification number	517368-000
Number of Individuals Covered	102
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 $3,058
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
Amount paid for insurance broker fees	3058
Insurance broker organization code?	5

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

517368-000

Policy instance

Insurance contract or identification number	517368-000
Number of Individuals Covered	99
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 $2,432
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
Amount paid for insurance broker fees	2432
Insurance broker organization code?	5

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Company Name:	UPSTATE COMMUNITY MEDICAL, PC
Employer identification number (EIN):	203889761
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)