401k Plan data: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) plan

PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 401k Plan overview

Plan Name	PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B)
Plan identification number	001

PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

PIEDMONT ACCESS TO HEALTH SERVICES, INC has sponsored the creation of one or more 401k plans.

Company Name: PIEDMONT ACCESS TO HEALTH SERVICES, INC

Employer identification number (EIN): 542026502

NAIC Classification: 621399
NAIC Description: Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B)

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01
001 2022-01-01
001 2021-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2018-01-01
001 2018-01-01
001 2017-01-01 JOANIE LITTLETON 2018-07-24 JOANIE LITTLETON 2018-07-24
001 2016-01-01 JOANIE LITTLETON 2017-05-12 JOANIE LITTLETON 2017-05-12
001 2016-01-01 JOANIE LITTLETON 2017-05-12 JOANIE LITTLETON 2017-05-12
001 2015-01-01 JOANIE LITTLETON 2016-07-12 JOANIE LITTLETON 2016-07-12
001 2015-01-01 JOANIE LITTLETON 2016-07-12 JOANIE LITTLETON 2016-07-12
001 2014-01-01 JOANIE LITTLETON 2015-05-04 JOANIE LITTLETON 2015-05-04

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2023-01-01
001	2022-01-01
001	2021-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2018-01-01
001	2018-01-01
001	2017-01-01	JOANIE LITTLETON	2018-07-24	JOANIE LITTLETON	2018-07-24
001	2016-01-01	JOANIE LITTLETON	2017-05-12	JOANIE LITTLETON	2017-05-12
001	2016-01-01	JOANIE LITTLETON	2017-05-12	JOANIE LITTLETON	2017-05-12
001	2015-01-01	JOANIE LITTLETON	2016-07-12	JOANIE LITTLETON	2016-07-12
001	2015-01-01	JOANIE LITTLETON	2016-07-12	JOANIE LITTLETON	2016-07-12
001	2014-01-01	JOANIE LITTLETON	2015-05-04	JOANIE LITTLETON	2015-05-04

Plan Statistics for PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B)

401k plan membership statisitcs for PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B)

Measure Date Value
2023: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2023 401k membership
Total participants, beginning-of-year 2023-01-01 326
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 318
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 23
Total of all active and inactive participants 2023-01-01 341
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 341
Number of participants with account balances 2023-01-01 281
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 26
2022: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2022 401k membership
Total participants, beginning-of-year 2022-01-01 266
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 277
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 9
Total of all active and inactive participants 2022-01-01 286
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 286
Number of participants with account balances 2022-01-01 140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 3
2021: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2021 401k membership
Total participants, beginning-of-year 2021-01-01 229
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 227
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 27
Total of all active and inactive participants 2021-01-01 254
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 255
Number of participants with account balances 2021-01-01 130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2020 401k membership
Total participants, beginning-of-year 2020-01-01 201
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 95
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 31
Total of all active and inactive participants 2020-01-01 126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 1
Total participants 2020-01-01 127
Number of participants with account balances 2020-01-01 122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 3
2019: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2019 401k membership
Total participants, beginning-of-year 2019-01-01 157
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 181
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 19
Total of all active and inactive participants 2019-01-01 200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 1
Total participants 2019-01-01 201
Number of participants with account balances 2019-01-01 113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 1
2018: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2018 401k membership
Total participants, beginning-of-year 2018-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 150
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 18
Total of all active and inactive participants 2018-01-01 168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 1
Total participants 2018-01-01 169
Number of participants with account balances 2018-01-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 1

Measure	Date	Value
2023: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2023 401k membership
Total participants, beginning-of-year	2023-01-01	326
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	318
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	23
Total of all active and inactive participants	2023-01-01	341
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	341
Number of participants with account balances	2023-01-01	281
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	26
2022: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2022 401k membership
Total participants, beginning-of-year	2022-01-01	266
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	277
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	9
Total of all active and inactive participants	2022-01-01	286
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	286
Number of participants with account balances	2022-01-01	140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	3
2021: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2021 401k membership
Total participants, beginning-of-year	2021-01-01	229
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	227
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	27
Total of all active and inactive participants	2021-01-01	254
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	255
Number of participants with account balances	2021-01-01	130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2020 401k membership
Total participants, beginning-of-year	2020-01-01	201
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	95
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	31
Total of all active and inactive participants	2020-01-01	126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	1
Total participants	2020-01-01	127
Number of participants with account balances	2020-01-01	122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	3
2019: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2019 401k membership
Total participants, beginning-of-year	2019-01-01	157
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	181
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	19
Total of all active and inactive participants	2019-01-01	200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	201
Number of participants with account balances	2019-01-01	113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	1
2018: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2018 401k membership
Total participants, beginning-of-year	2018-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	150
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	18
Total of all active and inactive participants	2018-01-01	168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	169
Number of participants with account balances	2018-01-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	1

Financial Data on PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B)

Measure	Date	Value
2023 : PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total income from all sources (including contributions)	2023-12-31	$2,361,580
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$259,999
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$195,621
Value of total corrective distributions	2023-12-31	$10,268
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$1,307,488
Value of total assets at end of year	2023-12-31	$6,836,937
Value of total assets at beginning of year	2023-12-31	$4,735,356
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$54,110
Total interest from all sources	2023-12-31	$19,871
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$110,236
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2023-12-31	$110,236
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2023-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-12-31	No
Contributions received from participants	2023-12-31	$917,731
Participant contributions at end of year	2023-12-31	$101,147
Participant contributions at beginning of year	2023-12-31	$35,798
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$9,283
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Value of net income/loss	2023-12-31	$2,101,581
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$6,836,937
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$4,735,356
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-12-31	No
Were any leases to which the plan was party in default or uncollectible	2023-12-31	No
Investment advisory and management fees	2023-12-31	$33,933
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-12-31	$6,355,440
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-12-31	$4,196,080
Interest on participant loans	2023-12-31	$4,994
Interest earned on other investments	2023-12-31	$14,877
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2023-12-31	$380,350
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2023-12-31	$503,478
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-12-31	$923,985
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-12-31	No
Was there a failure to transmit to the plan any participant contributions	2023-12-31	No
Has the plan failed to provide any benefit when due under the plan	2023-12-31	No
Contributions received in cash from employer	2023-12-31	$380,474
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$195,621
Contract administrator fees	2023-12-31	$20,177
Did the plan have assets held for investment	2023-12-31	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	2023-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-12-31	No
Opinion of an independent qualified public accountant for this plan	2023-12-31	Qualified
Accountancy firm name	2023-12-31	ROBINSON FARMER COX ASSOCIATES PLLC
Accountancy firm EIN	2023-12-31	541896113
2022 : PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$239,610
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$157,960
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$147,276
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$904,666
Value of total assets at end of year	2022-12-31	$4,735,356
Value of total assets at beginning of year	2022-12-31	$4,653,706
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$10,684
Total interest from all sources	2022-12-31	$11,372
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$61,758
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	$61,758
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$590,906
Participant contributions at end of year	2022-12-31	$35,798
Participant contributions at beginning of year	2022-12-31	$16,145
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$62,006
Other income not declared elsewhere	2022-12-31	$-269,474
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	$81,650
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,735,356
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$4,653,706
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$4,196,080
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$4,004,581
Interest on participant loans	2022-12-31	$1,695
Interest earned on other investments	2022-12-31	$9,677
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$503,478
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$632,980
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-468,712
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	$251,754
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$147,276
Contract administrator fees	2022-12-31	$10,684
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2022-12-31	Yes
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	Qualified
Accountancy firm name	2022-12-31	ROBINSON, FARMER, COX ASSOCIATES,
Accountancy firm EIN	2022-12-31	541896113
2021 : PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$1,288,441
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$223,443
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$222,893
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$823,550
Value of total assets at end of year	2021-12-31	$4,653,706
Value of total assets at beginning of year	2021-12-31	$3,588,708
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$550
Total interest from all sources	2021-12-31	$13,548
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
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	$4,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$427,396
Participant contributions at end of year	2021-12-31	$16,145
Participant contributions at beginning of year	2021-12-31	$22,440
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$183,736
Administrative expenses (other) incurred	2021-12-31	$550
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	$1,064,998
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$4,653,706
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$3,588,708
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	$4,004,581
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$3,014,818
Interest on participant loans	2021-12-31	$1,462
Interest earned on other investments	2021-12-31	$12,086
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$632,980
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$551,450
Net investment gain/loss from pooled separate accounts	2021-12-31	$451,343
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	$212,418
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$222,893
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	Disclaimer
Accountancy firm name	2021-12-31	YESHIVA OF NEW HAVEN
Accountancy firm EIN	2021-12-31	202102404
2020 : PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 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	$0
Total income from all sources (including contributions)	2020-12-31	$933,427
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$88,213
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$87,488
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$522,541
Value of total assets at end of year	2020-12-31	$3,588,708
Value of total assets at beginning of year	2020-12-31	$2,743,494
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$725
Total interest from all sources	2020-12-31	$11,163
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	$4,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$341,970
Participant contributions at end of year	2020-12-31	$22,440
Participant contributions at beginning of year	2020-12-31	$21,618
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$3,681
Administrative expenses (other) incurred	2020-12-31	$725
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	$845,214
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,588,708
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,743,494
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	$3,014,818
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$2,277,674
Interest on participant loans	2020-12-31	$1,248
Interest earned on other investments	2020-12-31	$9,915
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$551,450
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$444,202
Net investment gain/loss from pooled separate accounts	2020-12-31	$399,723
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	$176,890
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$87,488
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	Disclaimer
Accountancy firm name	2020-12-31	PETWAY MILLS & PEARSON
Accountancy firm EIN	2020-12-31	202102404
2019 : PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$875,068
Total income from all sources (including contributions)	2019-12-31	$875,068
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$62,113
Total of all expenses incurred	2019-12-31	$62,113
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$61,563
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$61,563
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$490,602
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$490,602
Value of total assets at end of year	2019-12-31	$2,743,494
Value of total assets at end of year	2019-12-31	$2,743,494
Value of total assets at beginning of year	2019-12-31	$1,930,539
Value of total assets at beginning of year	2019-12-31	$1,930,539
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$550
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$550
Total interest from all sources	2019-12-31	$8,747
Total interest from all sources	2019-12-31	$8,747
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
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	$350,000
Value of fidelity bond cover	2019-12-31	$350,000
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$300,249
Contributions received from participants	2019-12-31	$300,249
Participant contributions at end of year	2019-12-31	$21,618
Participant contributions at end of year	2019-12-31	$21,618
Participant contributions at beginning of year	2019-12-31	$21,704
Participant contributions at beginning of year	2019-12-31	$21,704
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$36,395
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$36,395
Administrative expenses (other) incurred	2019-12-31	$550
Administrative expenses (other) incurred	2019-12-31	$550
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	$812,955
Value of net income/loss	2019-12-31	$812,955
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,743,494
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,743,494
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,930,539
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,930,539
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,277,674
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,277,674
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,562,798
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,562,798
Interest on participant loans	2019-12-31	$946
Interest on participant loans	2019-12-31	$946
Interest earned on other investments	2019-12-31	$7,801
Interest earned on other investments	2019-12-31	$7,801
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$444,202
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$444,202
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$346,037
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$346,037
Net investment gain/loss from pooled separate accounts	2019-12-31	$375,719
Net investment gain/loss from pooled separate accounts	2019-12-31	$375,719
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	Yes
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
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	$153,958
Contributions received in cash from employer	2019-12-31	$153,958
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$61,563
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$61,563
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
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
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
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	PETWAY MILLS & PEARSON
Accountancy firm name	2019-12-31	PETWAY MILLS & PEARSON
Accountancy firm EIN	2019-12-31	202102404
Accountancy firm EIN	2019-12-31	202102404
2018 : PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$289,489
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$268,303
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$267,090
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$403,969
Value of total assets at end of year	2018-12-31	$1,930,539
Value of total assets at beginning of year	2018-12-31	$1,909,353
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$1,213
Total interest from all sources	2018-12-31	$7,649
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
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	No
Contributions received from participants	2018-12-31	$247,053
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$18,093
Assets. Loans (other than to participants) at end of year	2018-12-31	$21,704
Assets. Loans (other than to participants) at beginning of year	2018-12-31	$15,893
Administrative expenses (other) incurred	2018-12-31	$1,213
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	$21,186
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,930,539
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,909,353
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	$1,562,798
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$1,436,561
Interest earned on other investments	2018-12-31	$7,649
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$346,037
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$456,899
Net investment gain/loss from pooled separate accounts	2018-12-31	$-122,129
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$138,823
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$267,090
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	Qualified
Accountancy firm name	2018-12-31	PETWAY, PEARSON & MILLS, PA
Accountancy firm EIN	2018-12-31	202102404

Form 5500 Responses for PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B)

2023: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 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
2020: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 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
2019: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 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
2018: PIEDMONT ACCESS TO HEALTH SERVICES, INC 403(B) 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

88072

Policy instance

Insurance contract or identification number	88072
Number of Individuals Covered	54
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

88072

Policy instance

Insurance contract or identification number	88072
Number of Individuals Covered	54
Insurance policy start date	2022-02-19
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-753323

Policy instance

Insurance contract or identification number	GA-753323
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-753323

Policy instance

Insurance contract or identification number	GA-753323
Number of Individuals Covered	122
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,110
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,110
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-753323

Policy instance

Insurance contract or identification number	GA-753323
Number of Individuals Covered	113
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $8,696
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,696
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA753323

Policy instance

Insurance contract or identification number	GA753323
Number of Individuals Covered	109
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $10,190
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $10,190
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	PIEDMONT ACCESS TO HEALTH SERVICES, INC
Employer identification number (EIN):	542026502
NAIC Classification:	621399
NAIC Description:	Offices of All Other Miscellaneous Health Practitioners