401k Plan data: PENINSULA FAMILY SERVICE 403(B) PLAN plan

PENINSULA FAMILY SERVICE 403(B) PLAN 401k Plan overview

Plan Name	PENINSULA FAMILY SERVICE 403(B) PLAN
Plan identification number	001

PENINSULA FAMILY SERVICE 403(B) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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

PENINSULA FAMILY SERVICE has sponsored the creation of one or more 401k plans.

Company Name: PENINSULA FAMILY SERVICE

Employer identification number (EIN): 941186169

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Additional information about PENINSULA FAMILY SERVICE

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C0244584

More information about PENINSULA FAMILY SERVICE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PENINSULA FAMILY SERVICE 403(B) PLAN

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 2020-01-01
001 2019-01-01
001 2019-01-01
001 2018-01-01

Plan Statistics for PENINSULA FAMILY SERVICE 403(B) PLAN

401k plan membership statisitcs for PENINSULA FAMILY SERVICE 403(B) PLAN

Measure Date Value
2023: PENINSULA FAMILY SERVICE 403(B) PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 220
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 168
Number of retired or separated participants receiving benefits 2023-01-01 17
Number of other retired or separated participants entitled to future benefits 2023-01-01 36
Total of all active and inactive participants 2023-01-01 221
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 221
Number of participants with account balances 2023-01-01 193
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 5
2022: PENINSULA FAMILY SERVICE 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 181
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 138
Number of retired or separated participants receiving benefits 2022-01-01 19
Number of other retired or separated participants entitled to future benefits 2022-01-01 63
Total of all active and inactive participants 2022-01-01 220
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 220
Number of participants with account balances 2022-01-01 208
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 11
2021: PENINSULA FAMILY SERVICE 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 170
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 127
Number of retired or separated participants receiving benefits 2021-01-01 14
Number of other retired or separated participants entitled to future benefits 2021-01-01 39
Total of all active and inactive participants 2021-01-01 180
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 180
Number of participants with account balances 2021-01-01 168
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 2
2020: PENINSULA FAMILY SERVICE 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 127
Number of retired or separated participants receiving benefits 2020-01-01 3
Number of other retired or separated participants entitled to future benefits 2020-01-01 33
Total of all active and inactive participants 2020-01-01 163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 163
Number of participants with account balances 2020-01-01 138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 2
2019: PENINSULA FAMILY SERVICE 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 136
Number of retired or separated participants receiving benefits 2019-01-01 3
Number of other retired or separated participants entitled to future benefits 2019-01-01 33
Total of all active and inactive participants 2019-01-01 172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 172
Number of participants with account balances 2019-01-01 144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 7
2018: PENINSULA FAMILY SERVICE 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 221
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 140
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 22
Total of all active and inactive participants 2018-01-01 163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 163
Number of participants with account balances 2018-01-01 133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 5

Measure	Date	Value
2023: PENINSULA FAMILY SERVICE 403(B) PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	220
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	168
Number of retired or separated participants receiving benefits	2023-01-01	17
Number of other retired or separated participants entitled to future benefits	2023-01-01	36
Total of all active and inactive participants	2023-01-01	221
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	221
Number of participants with account balances	2023-01-01	193
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	5
2022: PENINSULA FAMILY SERVICE 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	181
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	138
Number of retired or separated participants receiving benefits	2022-01-01	19
Number of other retired or separated participants entitled to future benefits	2022-01-01	63
Total of all active and inactive participants	2022-01-01	220
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	220
Number of participants with account balances	2022-01-01	208
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	11
2021: PENINSULA FAMILY SERVICE 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	170
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	127
Number of retired or separated participants receiving benefits	2021-01-01	14
Number of other retired or separated participants entitled to future benefits	2021-01-01	39
Total of all active and inactive participants	2021-01-01	180
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	180
Number of participants with account balances	2021-01-01	168
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	2
2020: PENINSULA FAMILY SERVICE 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	127
Number of retired or separated participants receiving benefits	2020-01-01	3
Number of other retired or separated participants entitled to future benefits	2020-01-01	33
Total of all active and inactive participants	2020-01-01	163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	163
Number of participants with account balances	2020-01-01	138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	2
2019: PENINSULA FAMILY SERVICE 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	136
Number of retired or separated participants receiving benefits	2019-01-01	3
Number of other retired or separated participants entitled to future benefits	2019-01-01	33
Total of all active and inactive participants	2019-01-01	172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	172
Number of participants with account balances	2019-01-01	144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	7
2018: PENINSULA FAMILY SERVICE 403(B) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	221
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	140
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	22
Total of all active and inactive participants	2018-01-01	163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	163
Number of participants with account balances	2018-01-01	133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	5

Financial Data on PENINSULA FAMILY SERVICE 403(B) PLAN

Measure	Date	Value
2023 : PENINSULA FAMILY SERVICE 403(B) PLAN 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	$1,334,001
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$703,354
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$671,338
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$667,429
Value of total assets at end of year	2023-12-31	$4,815,435
Value of total assets at beginning of year	2023-12-31	$4,184,788
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$32,016
Total interest from all sources	2023-12-31	$17,062
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$116,474
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	$116,474
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$500,000
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	$449,116
Participant contributions at end of year	2023-12-31	$83,749
Participant contributions at beginning of year	2023-12-31	$32,583
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$916
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2023-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2023-12-31	$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	2023-12-31	No
Value of net income/loss	2023-12-31	$630,647
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$4,815,435
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$4,184,788
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-12-31	$4,106,631
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-12-31	$3,571,544
Value of interest in pooled separate accounts at end of year	2023-12-31	$296,510
Value of interest in pooled separate accounts at beginning of year	2023-12-31	$258,251
Interest on participant loans	2023-12-31	$4,657
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2023-12-31	$272,683
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2023-12-31	$220,356
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2023-12-31	$220,356
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2023-12-31	$12,405
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2023-12-31	$55,862
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2023-12-31	$102,054
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-12-31	$483,523
Net investment gain/loss from pooled separate accounts	2023-12-31	$49,513
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	Yes
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	$217,397
Employer contributions (assets) at end of year	2023-12-31	$0
Employer contributions (assets) at beginning of year	2023-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$671,338
Contract administrator fees	2023-12-31	$32,016
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	Unqualified
Accountancy firm name	2023-12-31	ARMANINO, LLP
Accountancy firm EIN	2023-12-31	946214841
2022 : PENINSULA FAMILY SERVICE 403(B) PLAN 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	$596,851
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$461,946
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$446,928
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,206,216
Value of total assets at end of year	2022-12-31	$4,184,788
Value of total assets at beginning of year	2022-12-31	$4,049,883
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$15,018
Total interest from all sources	2022-12-31	$5,114
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$100,919
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	$100,919
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$407,280
Participant contributions at end of year	2022-12-31	$32,583
Participant contributions at beginning of year	2022-12-31	$46,458
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$885
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$0
Administrative expenses (other) incurred	2022-12-31	$15,018
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	$134,905
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,184,788
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$4,049,883
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	$3,571,544
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$3,417,382
Value of interest in pooled separate accounts at end of year	2022-12-31	$258,251
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$310,461
Income. Interest from loans (other than to participants)	2022-12-31	$2,070
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$220,356
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$174,525
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$174,525
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$3,044
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$102,054
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$101,057
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-666,756
Net investment gain/loss from pooled separate accounts	2022-12-31	$-48,642
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	$798,051
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$446,928
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	ARMANINO, LLP
Accountancy firm EIN	2022-12-31	946214841
2021 : PENINSULA FAMILY SERVICE 403(B) PLAN 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	$1,091
Total income from all sources (including contributions)	2021-12-31	$1,557,638
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$125,661
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$107,667
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$1,192,076
Value of total assets at end of year	2021-12-31	$4,049,883
Value of total assets at beginning of year	2021-12-31	$2,618,997
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$17,994
Total interest from all sources	2021-12-31	$2,805
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$394,936
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$394,936
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
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	$413,089
Participant contributions at end of year	2021-12-31	$46,458
Participant contributions at beginning of year	2021-12-31	$52,319
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$907
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$1,091
Administrative expenses (other) incurred	2021-12-31	$17,994
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	$1,431,977
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$4,049,883
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$2,617,906
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	$3,591,907
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,173,050
Value of interest in pooled separate accounts at end of year	2021-12-31	$310,461
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$288,083
Interest on participant loans	2021-12-31	$2,805
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$101,057
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$101,699
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$-78,982
Net investment gain/loss from pooled separate accounts	2021-12-31	$46,803
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	Yes
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	$778,080
Employer contributions (assets) at end of year	2021-12-31	$0
Employer contributions (assets) at beginning of year	2021-12-31	$3,846
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$107,667
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	ARMANINO, LLP
Accountancy firm EIN	2021-12-31	946214841
2020 : PENINSULA FAMILY SERVICE 403(B) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$1,091
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$765
Total income from all sources (including contributions)	2020-12-31	$917,033
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$155,861
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$140,145
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$598,837
Value of total assets at end of year	2020-12-31	$2,618,997
Value of total assets at beginning of year	2020-12-31	$1,857,499
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$15,716
Total interest from all sources	2020-12-31	$2,570
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$63,943
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$63,943
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
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	$336,150
Participant contributions at end of year	2020-12-31	$52,319
Participant contributions at beginning of year	2020-12-31	$26,970
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$107,070
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$1,091
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$765
Administrative expenses (other) incurred	2020-12-31	$15,716
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	$761,172
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$2,617,906
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,856,734
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	$2,173,050
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,452,965
Value of interest in pooled separate accounts at end of year	2020-12-31	$288,083
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$266,892
Interest on participant loans	2020-12-31	$2,570
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$101,699
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$103,195
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$251,683
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	Yes
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	$155,617
Employer contributions (assets) at end of year	2020-12-31	$3,846
Employer contributions (assets) at beginning of year	2020-12-31	$7,477
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$140,145
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	ARMANINO, LLP
Accountancy firm EIN	2020-12-31	949214841
2019 : PENINSULA FAMILY SERVICE 403(B) PLAN 2019 401k financial data
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	$765
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	$1,037,867
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$464,254
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$444,271
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$521,385
Value of total assets at end of year	2019-12-31	$1,857,499
Value of total assets at beginning of year	2019-12-31	$1,283,121
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$19,983
Total interest from all sources	2019-12-31	$1,036
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$61,725
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$61,725
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
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
Contributions received from participants	2019-12-31	$348,719
Participant contributions at end of year	2019-12-31	$26,970
Participant contributions at beginning of year	2019-12-31	$1,101
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$17,931
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$765
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$0
Administrative expenses (other) incurred	2019-12-31	$19,983
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	$573,613
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,856,734
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,283,121
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	$1,452,965
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$919,551
Value of interest in pooled separate accounts at end of year	2019-12-31	$266,892
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$244,593
Interest on participant loans	2019-12-31	$1,036
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$103,195
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$117,876
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$453,721
Net investment gain or loss from common/collective trusts	2019-12-31	$0
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
Contributions received in cash from employer	2019-12-31	$154,735
Employer contributions (assets) at end of year	2019-12-31	$7,477
Employer contributions (assets) at beginning of year	2019-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$444,271
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	ARMANINO, LLP
Accountancy firm EIN	2019-12-31	949214841
2018 : PENINSULA FAMILY SERVICE 403(B) PLAN 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	$106,706
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$970,020
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$958,065
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$404,082
Value of total assets at end of year	2018-12-31	$1,283,121
Value of total assets at beginning of year	2018-12-31	$2,146,435
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$11,955
Total interest from all sources	2018-12-31	$51
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$44,065
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$44,065
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$334,966
Participant contributions at end of year	2018-12-31	$1,101
Participant contributions at beginning of year	2018-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$8,723
Other income not declared elsewhere	2018-12-31	$7,598
Administrative expenses (other) incurred	2018-12-31	$11,955
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	$-863,314
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,283,121
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,146,435
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	$919,551
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$911,910
Value of interest in pooled separate accounts at end of year	2018-12-31	$244,593
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$868,335
Interest on participant loans	2018-12-31	$51
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$117,876
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$366,190
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-349,090
Net investment gain or loss from common/collective trusts	2018-12-31	$0
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	$60,393
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$958,065
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	2018-12-31	No
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	ARMANINO, LLP
Accountancy firm EIN	2018-12-31	949214841

Form 5500 Responses for PENINSULA FAMILY SERVICE 403(B) PLAN

2023: PENINSULA FAMILY SERVICE 403(B) PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
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: PENINSULA FAMILY SERVICE 403(B) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: PENINSULA FAMILY SERVICE 403(B) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: PENINSULA FAMILY SERVICE 403(B) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: PENINSULA FAMILY SERVICE 403(B) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: PENINSULA FAMILY SERVICE 403(B) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	First time form 5500 has been submitted	Yes
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
2018-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )

Policy contract number

94-1186169

Policy instance

Insurance contract or identification number	94-1186169
Number of Individuals Covered	20
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 $94
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

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )

Policy contract number

94-1186169

Policy instance

Insurance contract or identification number	94-1186169
Number of Individuals Covered	22
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $23
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
Amount paid for insurance broker fees	23
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )

Policy contract number

94-1186169

Policy instance

Insurance contract or identification number	94-1186169
Number of Individuals Covered	127
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $23
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
Amount paid for insurance broker fees	23
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )

Policy contract number

94-1186169

Policy instance

Insurance contract or identification number	94-1186169
Number of Individuals Covered	127
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $19
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
Amount paid for insurance broker fees	19
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )

Policy contract number

94-1186169

Policy instance

Insurance contract or identification number	94-1186169
Number of Individuals Covered	136
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $5
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
Amount paid for insurance broker fees	5
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )

Policy contract number

94-1186169

Policy instance

Insurance contract or identification number	94-1186169
Number of Individuals Covered	140
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1
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
Amount paid for insurance broker fees	1
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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Company Name:	PENINSULA FAMILY SERVICE
Employer identification number (EIN):	941186169
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C0244584