401k Plan data: NORTHWAY BANK FLEXIBLE BENEFITS PLAN plan

NORTHWAY BANK FLEXIBLE BENEFITS PLAN 401k Plan overview

Plan Name	NORTHWAY BANK FLEXIBLE BENEFITS PLAN
Plan identification number	502

NORTHWAY BANK FLEXIBLE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name: NORTHWAY BANK

Employer identification number (EIN): 020108854

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHWAY BANK FLEXIBLE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-01-01 STACY POIRIER 2024-03-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2023-01-01	STACY POIRIER	2024-03-27

Plan Statistics for NORTHWAY BANK FLEXIBLE BENEFITS PLAN

401k plan membership statisitcs for NORTHWAY BANK FLEXIBLE BENEFITS PLAN

Measure Date Value
2023: NORTHWAY BANK FLEXIBLE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 195
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 200
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 200
Number of employers contributing to the scheme 2023-01-01 0

Measure	Date	Value
2023: NORTHWAY BANK FLEXIBLE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	195
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	200
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	200
Number of employers contributing to the scheme	2023-01-01	0

Form 5500 Responses for NORTHWAY BANK FLEXIBLE BENEFITS PLAN

2023: NORTHWAY BANK FLEXIBLE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

233394

Policy instance

Insurance contract or identification number	233394
Number of Individuals Covered	200
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $11,014
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $174,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RED TREE INSURANCE COMPANY, INC. (National Association of Insurance Commissioners NAIC id number: 13646 )

Policy contract number

903640

Policy instance

Insurance contract or identification number	903640
Number of Individuals Covered	223
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,398
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARVARD PILGRIM HEALTH CARE OF NE, INC. (National Association of Insurance Commissioners NAIC id number: 96917 )

Policy contract number

1052010000

Policy instance

Insurance contract or identification number	1052010000
Number of Individuals Covered	229
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $52,277
Total amount of fees paid to insurance company	USD $0
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
Welfare Benefit Premiums Paid to Carrier	USD $2,061,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )

Policy contract number

1052020000

Policy instance

Insurance contract or identification number	1052020000
Number of Individuals Covered	35
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $9,479
Total amount of fees paid to insurance company	USD $0
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
Welfare Benefit Premiums Paid to Carrier	USD $370,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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Company Name:	NORTHWAY BANK
Employer identification number (EIN):	020108854
NAIC Classification:	522110
NAIC Description:	Commercial Banking