401k Plan data: EXCHANGE BANK HEALTH AND WELFARE PLAN plan

EXCHANGE BANK HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	EXCHANGE BANK HEALTH AND WELFARE PLAN
Plan identification number	507

EXCHANGE BANK HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

EXCHANGE BANK has sponsored the creation of one or more 401k plans.

Company Name: EXCHANGE BANK

Employer identification number (EIN): 940463800

NAIC Classification: 522110
NAIC Description: Commercial Banking

Additional information about EXCHANGE BANK

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 731840

More information about EXCHANGE BANK

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EXCHANGE BANK HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2022-01-01 LORI ZARET 2023-10-12
507 2021-01-01 LORI ZARET 2022-10-14
507 2020-01-01 LORI ZARET 2021-10-08
507 2019-01-01 LORI T ZARET 2020-12-13
507 2018-01-01 LORI T. ZARET 2019-10-10
507 2017-01-01
507 2016-01-01 LORI T ZARET
507 2015-01-01 LORI ZARET
507 2014-01-01 LORI T. ZARET
507 2013-01-01 LORI T. ZARET
507 2012-01-01 LORI T ZARET
507 2011-01-01 LORI T. ZARET
507 2009-01-01 BRUCE DECRONA

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
507	2022-01-01	LORI ZARET	2023-10-12
507	2021-01-01	LORI ZARET	2022-10-14
507	2020-01-01	LORI ZARET	2021-10-08
507	2019-01-01	LORI T ZARET	2020-12-13
507	2018-01-01	LORI T. ZARET	2019-10-10
507	2017-01-01
507	2016-01-01	LORI T ZARET
507	2015-01-01	LORI ZARET
507	2014-01-01	LORI T. ZARET
507	2013-01-01	LORI T. ZARET
507	2012-01-01	LORI T ZARET
507	2011-01-01	LORI T. ZARET
507	2009-01-01	BRUCE DECRONA

Plan Statistics for EXCHANGE BANK HEALTH AND WELFARE PLAN

401k plan membership statisitcs for EXCHANGE BANK HEALTH AND WELFARE PLAN

Measure Date Value
2022: EXCHANGE BANK HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 0
Number of retired or separated participants receiving benefits 2022-01-01 136
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 136
Number of employers contributing to the scheme 2022-01-01 0
2021: EXCHANGE BANK HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 0
Number of retired or separated participants receiving benefits 2021-01-01 136
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 136
Number of employers contributing to the scheme 2021-01-01 0
2020: EXCHANGE BANK HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
Number of retired or separated participants receiving benefits 2020-01-01 132
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 132
Number of employers contributing to the scheme 2020-01-01 0
2019: EXCHANGE BANK HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 132
Number of retired or separated participants receiving benefits 2019-01-01 2
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 134
2018: EXCHANGE BANK HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 131
Number of retired or separated participants receiving benefits 2018-01-01 5
Number of other retired or separated participants entitled to future benefits 2018-01-01 3
Total of all active and inactive participants 2018-01-01 139
2017: EXCHANGE BANK HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 118
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 118
2016: EXCHANGE BANK HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 119
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 119
2015: EXCHANGE BANK HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 124
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 124
2014: EXCHANGE BANK HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 115
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 115
2013: EXCHANGE BANK HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 110
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 110
2012: EXCHANGE BANK HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 89
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 2012-01-01 102
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 102
2011: EXCHANGE BANK HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 86
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
Number of retired or separated participants receiving benefits 2011-01-01 89
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 89
2009: EXCHANGE BANK HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 87
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 0
Number of retired or separated participants receiving benefits 2009-01-01 88
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 88

Measure	Date	Value
2022: EXCHANGE BANK HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	0
Number of retired or separated participants receiving benefits	2022-01-01	136
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	136
Number of employers contributing to the scheme	2022-01-01	0
2021: EXCHANGE BANK HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	0
Number of retired or separated participants receiving benefits	2021-01-01	136
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	136
Number of employers contributing to the scheme	2021-01-01	0
2020: EXCHANGE BANK HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Number of retired or separated participants receiving benefits	2020-01-01	132
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	132
Number of employers contributing to the scheme	2020-01-01	0
2019: EXCHANGE BANK HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	132
Number of retired or separated participants receiving benefits	2019-01-01	2
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	134
2018: EXCHANGE BANK HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	131
Number of retired or separated participants receiving benefits	2018-01-01	5
Number of other retired or separated participants entitled to future benefits	2018-01-01	3
Total of all active and inactive participants	2018-01-01	139
2017: EXCHANGE BANK HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	118
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	118
2016: EXCHANGE BANK HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	119
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	119
2015: EXCHANGE BANK HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	124
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	124
2014: EXCHANGE BANK HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	115
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	115
2013: EXCHANGE BANK HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	110
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	110
2012: EXCHANGE BANK HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	89
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	102
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	102
2011: EXCHANGE BANK HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	86
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
Number of retired or separated participants receiving benefits	2011-01-01	89
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	89
2009: EXCHANGE BANK HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	87
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	0
Number of retired or separated participants receiving benefits	2009-01-01	88
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	88

Financial Data on EXCHANGE BANK HEALTH AND WELFARE PLAN

Measure	Date	Value
2022 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$105,139
Total of all expenses incurred	2022-12-31	$493,166
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$475,503
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$43,997
Value of total assets at end of year	2022-12-31	$5,979,180
Value of total assets at beginning of year	2022-12-31	$6,367,207
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$17,663
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$61,142
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$10,000,000
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$41,275
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$39,960
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-12-31	$3,174
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$417,143
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-12-31	$436,543
Administrative expenses (other) incurred	2022-12-31	$17,663
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	$-388,027
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$5,979,180
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$6,367,207
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 beginning of year	2022-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$5,520,762
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$5,890,704
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$5,890,704
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	Yes
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	$43,997
Income. Dividends from preferred stock	2022-12-31	$61,142
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$472,329
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	MOSS ADAMS
Accountancy firm EIN	2022-12-31	910189318
2021 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2021 401k financial data
Unrealized appreciation/depreciation of real estate assets	2021-12-31	$-10,512
Total unrealized appreciation/depreciation of assets	2021-12-31	$-10,512
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$350,158
Total income from all sources (including contributions)	2021-12-31	$2,968,415
Total of all expenses incurred	2021-12-31	$394,676
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$401,352
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$2,935,595
Value of total assets at end of year	2021-12-31	$6,367,207
Value of total assets at beginning of year	2021-12-31	$4,143,626
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$-6,676
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$43,332
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	$10,000,000
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	$75,827
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$39,960
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$185,473
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-12-31	$436,543
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$350,158
Administrative expenses (other) incurred	2021-12-31	$-6,676
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	$2,573,739
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$6,367,207
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$3,793,468
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	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,333,306
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$5,890,704
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$1,624,847
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$1,624,847
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$138,421
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	Yes
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	$2,859,768
Income. Dividends from preferred stock	2021-12-31	$43,332
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$262,931
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	MOSS ADAMS
Accountancy firm EIN	2021-12-31	910189318
2020 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets	2020-12-31	$-218,070
Total unrealized appreciation/depreciation of assets	2020-12-31	$-218,070
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$350,158
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$445,014
Total income from all sources (including contributions)	2020-12-31	$979,333
Total of all expenses incurred	2020-12-31	$434,006
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$434,006
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,091,211
Value of total assets at end of year	2020-12-31	$4,143,626
Value of total assets at beginning of year	2020-12-31	$3,693,155
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$55,036
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	$10,000,000
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	$91,211
Assets. Other investments not covered elsewhere at end of year	2020-12-31	$185,473
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$291,146
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	$23,700
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$350,158
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$445,014
Other income not declared elsewhere	2020-12-31	$51,156
Liabilities. Value of operating payables 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	$545,327
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,793,468
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$3,248,141
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,333,306
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$3,267,274
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$1,624,847
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$111,035
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$111,035
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$126,918
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	Yes
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	$1,000,000
Employer contributions (assets) at beginning of year	2020-12-31	$0
Income. Dividends from preferred stock	2020-12-31	$55,036
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$307,088
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
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	MOSS ADAMS
Accountancy firm EIN	2020-12-31	910189318
2019 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2019 401k financial data
Unrealized appreciation/depreciation of real estate assets	2019-12-31	$584,143
Unrealized appreciation/depreciation of other (non real estate) assets	2019-12-31	$63,007
Total unrealized appreciation/depreciation of assets	2019-12-31	$647,150
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$445,014
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$399,992
Total income from all sources (including contributions)	2019-12-31	$831,572
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$684,643
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$684,643
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$110,366
Value of total assets at end of year	2019-12-31	$3,693,155
Value of total assets at beginning of year	2019-12-31	$3,501,204
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$0
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$74,056
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
Value of fidelity bond cover	2019-12-31	$10,000,000
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	Yes
Amount of non-exempt transactions with any party-in-interest	2019-12-31	$528,704
Contributions received from participants	2019-12-31	$110,366
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$291,146
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$434,987
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2019-12-31	$227,332
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$23,700
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$445,014
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$355,059
Liabilities. Value of operating payables at end of year	2019-12-31	$0
Liabilities. Value of operating payables at beginning of year	2019-12-31	$44,933
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	$580,079
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	$146,929
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,248,141
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,101,212
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 leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$3,267,274
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,324,290
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$111,035
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$161,848
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$161,848
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$148,669
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
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Income. Dividends from preferred stock	2019-12-31	$74,056
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$308,642
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
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	MOSS ADAMS
Accountancy firm EIN	2019-12-31	910189318
2018 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2018 401k financial data
Unrealized appreciation/depreciation of real estate assets	2018-12-31	$-229,033
Unrealized appreciation/depreciation of other (non real estate) assets	2018-12-31	$-33,437
Total unrealized appreciation/depreciation of assets	2018-12-31	$-262,470
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$399,992
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$538,878
Total income from all sources (including contributions)	2018-12-31	$-87,810
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$430,856
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$430,856
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$101,072
Value of total assets at end of year	2018-12-31	$3,501,204
Value of total assets at beginning of year	2018-12-31	$4,158,756
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$0
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$73,588
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	Yes
Amount of non-exempt transactions with any party-in-interest	2018-12-31	$479,363
Contributions received from participants	2018-12-31	$101,072
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$434,987
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$560,700
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2018-12-31	$-61,177
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$355,059
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$524,793
Liabilities. Value of operating payables at end of year	2018-12-31	$44,933
Liabilities. Value of operating payables at beginning of year	2018-12-31	$14,085
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	$-518,666
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,101,212
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$3,619,878
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
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$2,324,290
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$3,062,610
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$161,848
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$23,002
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$23,002
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$159,120
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
Employer contributions (assets) at end of year	2018-12-31	$580,079
Employer contributions (assets) at beginning of year	2018-12-31	$512,444
Income. Dividends from preferred stock	2018-12-31	$73,588
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$332,913
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
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	MOSS ADAMS
Accountancy firm EIN	2018-12-31	910189318
2017 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2017 401k financial data
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$575,759
Expenses. Total of all expenses incurred	2017-12-31	$566,829
Benefits paid (including direct rollovers)	2017-12-31	$483,974
Total plan assets at end of year	2017-12-31	$3,646,312
Total plan assets at beginning of year	2017-12-31	$3,637,382
Value of fidelity bond covering the plan	2017-12-31	$2,000,000
Total contributions received or receivable from participants	2017-12-31	$0
Expenses. Other expenses not covered elsewhere	2017-12-31	$71,510
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$575,759
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$8,930
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$3,646,312
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$3,637,382
Total contributions received or receivable from employer(s)	2017-12-31	$0
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$11,345
2016 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$315,051
Expenses. Total of all expenses incurred	2016-12-31	$531,210
Benefits paid (including direct rollovers)	2016-12-31	$407,314
Total plan assets at end of year	2016-12-31	$3,637,382
Total plan assets at beginning of year	2016-12-31	$3,853,541
Value of fidelity bond covering the plan	2016-12-31	$2,000,000
Total contributions received or receivable from participants	2016-12-31	$0
Expenses. Other expenses not covered elsewhere	2016-12-31	$105,055
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$315,051
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$-216,159
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$3,637,382
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$3,853,541
Total contributions received or receivable from employer(s)	2016-12-31	$0
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$18,841
2015 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$-868,498
Total income from all sources	2015-12-31	$13,499
Expenses. Total of all expenses incurred	2015-12-31	$-434,249
Benefits paid (including direct rollovers)	2015-12-31	$-382,794
Total plan assets at end of year	2015-12-31	$3,853,541
Total plan assets at beginning of year	2015-12-31	$4,274,291
Value of fidelity bond covering the plan	2015-12-31	$2,000,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$-37,010
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$13,499
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$447,748
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$3,853,541
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$4,274,291
Total contributions received or receivable from employer(s)	2015-12-31	$0
Value of certain deemed distributions of participant loans	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$-14,445
2014 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$318,189
Expenses. Total of all expenses incurred	2014-12-31	$478,875
Benefits paid (including direct rollovers)	2014-12-31	$350,960
Total plan assets at end of year	2014-12-31	$4,274,291
Total plan assets at beginning of year	2014-12-31	$4,434,977
Value of fidelity bond covering the plan	2014-12-31	$2,000,000
Expenses. Other expenses not covered elsewhere	2014-12-31	$127,915
Other income received	2014-12-31	$318,189
Net income (gross income less expenses)	2014-12-31	$-160,686
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$4,274,291
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$4,434,977
2013 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$124,120
Expenses. Total of all expenses incurred	2013-12-31	$265,756
Benefits paid (including direct rollovers)	2013-12-31	$198,135
Total plan assets at end of year	2013-12-31	$2,919,279
Total plan assets at beginning of year	2013-12-31	$3,060,915
Value of fidelity bond covering the plan	2013-12-31	$2,000,000
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$67,621
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$124,120
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$-141,636
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,919,279
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$3,060,915
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
2012 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$1,715,255
Expenses. Total of all expenses incurred	2012-12-31	$341,262
Benefits paid (including direct rollovers)	2012-12-31	$306,440
Total plan assets at end of year	2012-12-31	$3,060,915
Total plan assets at beginning of year	2012-12-31	$1,686,922
Value of fidelity bond covering the plan	2012-12-31	$2,000,000
Other income received	2012-12-31	$215,255
Net income (gross income less expenses)	2012-12-31	$1,373,993
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$3,060,915
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,686,922
Total contributions received or receivable from employer(s)	2012-12-31	$1,500,000
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$34,822
2011 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$123,563
Expenses. Total of all expenses incurred	2011-12-31	$353,093
Benefits paid (including direct rollovers)	2011-12-31	$314,614
Total plan assets at end of year	2011-12-31	$1,686,922
Total plan assets at beginning of year	2011-12-31	$1,916,452
Value of fidelity bond covering the plan	2011-12-31	$2,000,000
Expenses. Other expenses not covered elsewhere	2011-12-31	$38,479
Other income received	2011-12-31	$123,563
Net income (gross income less expenses)	2011-12-31	$-229,530
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,686,922
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,916,452
2010 : EXCHANGE BANK HEALTH AND WELFARE PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$141,104
Expenses. Total of all expenses incurred	2010-12-31	$313,795
Benefits paid (including direct rollovers)	2010-12-31	$301,650
Total plan assets at end of year	2010-12-31	$1,916,452
Total plan assets at beginning of year	2010-12-31	$2,089,143
Value of fidelity bond covering the plan	2010-12-31	$2,000,000
Expenses. Other expenses not covered elsewhere	2010-12-31	$12,145
Other income received	2010-12-31	$141,104
Net income (gross income less expenses)	2010-12-31	$-172,691
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,916,452
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,089,143

Form 5500 Responses for EXCHANGE BANK HEALTH AND WELFARE PLAN

2022: EXCHANGE BANK HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: EXCHANGE BANK HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: EXCHANGE BANK HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: EXCHANGE BANK HEALTH AND WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: EXCHANGE BANK HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: EXCHANGE BANK HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: EXCHANGE BANK HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: EXCHANGE BANK HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: EXCHANGE BANK HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: EXCHANGE BANK HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: EXCHANGE BANK HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
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: EXCHANGE BANK HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
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: EXCHANGE BANK HEALTH AND WELFARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
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 – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1962

Policy instance

Insurance contract or identification number	1962
Number of Individuals Covered	479
Insurance policy start date	2020-11-01
Insurance policy end date	2021-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,659,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1962

Policy instance

Insurance contract or identification number	1962
Number of Individuals Covered	504
Insurance policy start date	2019-11-01
Insurance policy end date	2020-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $5,576
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,734,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	5576
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1962

Policy instance

Insurance contract or identification number	1962
Number of Individuals Covered	533
Insurance policy start date	2018-11-01
Insurance policy end date	2019-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $3,807,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1962

Policy instance

Insurance contract or identification number	1962
Number of Individuals Covered	609
Insurance policy start date	2017-11-01
Insurance policy end date	2018-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $4,000,405
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1962

Policy instance

Insurance contract or identification number	1962
Number of Individuals Covered	604
Insurance policy start date	2016-11-01
Insurance policy end date	2017-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $3,831,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1962

Policy instance

Insurance contract or identification number	1962
Number of Individuals Covered	579
Insurance policy start date	2014-11-01
Insurance policy end date	2015-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with 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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $3,642,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1962

Policy instance

Insurance contract or identification number	1962
Number of Individuals Covered	581
Insurance policy start date	2013-11-01
Insurance policy end date	2014-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with 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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $3,864,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1962

Policy instance

Insurance contract or identification number	1962
Number of Individuals Covered	602
Insurance policy start date	2012-11-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with 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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $3,393,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1962

Policy instance

Insurance contract or identification number	1962
Number of Individuals Covered	627
Insurance policy start date	2011-11-01
Insurance policy end date	2012-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $577
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $3,585,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	577
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1962

Policy instance

Insurance contract or identification number	1962
Number of Individuals Covered	523
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with 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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $3,391,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

1962

Policy instance

Insurance contract or identification number	1962
Number of Individuals Covered	460
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with 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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $2,157,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )

Policy contract number

C70168

Policy instance

Insurance contract or identification number	C70168
Number of Individuals Covered	133
Insurance policy start date	2010-01-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $125
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $514,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	125
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES

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Company Name:	EXCHANGE BANK
Employer identification number (EIN):	940463800
NAIC Classification:	522110
NAIC Description:	Commercial Banking

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	731840