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403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 401k Plan overview

Plan Name403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME
Plan identification number 001

403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

FALL RIVER DEACONESS HOME has sponsored the creation of one or more 401k plans.

Company Name:FALL RIVER DEACONESS HOME
Employer identification number (EIN):042103766
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012021-07-01
0012020-07-01
0012019-07-01
0012018-07-01
0012017-07-01JOHN GOLDEN2019-01-30
0012017-07-01JOHN GOLDEN2019-01-30
0012016-07-01JOHN F. GOLDEN2018-03-05 JOHN F. GOLDEN2018-03-05
0012015-07-01JOHN F. GOLDEN2017-01-26
0012014-07-01JOHN F. GOLDEN2016-03-28
0012013-07-01JOHN F. GOLDEN2015-01-26
0012012-07-01JOHN F. GOLDEN2014-01-27
0012011-07-01JOHN F. GOLDEN2013-01-28
0012010-07-01JOHN F. GOLDEN2012-01-24

Plan Statistics for 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME

401k plan membership statisitcs for 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME

Measure Date Value
2021: 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2021 401k membership
Total participants, beginning-of-year2021-07-01137
Total number of active participants reported on line 7a of the Form 55002021-07-0196
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-0171
Total of all active and inactive participants2021-07-01167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-07-010
Total participants2021-07-01167
Number of participants with account balances2021-07-01136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-07-0113
2020: 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2020 401k membership
Total participants, beginning-of-year2020-07-01129
Total number of active participants reported on line 7a of the Form 55002020-07-0193
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-0144
Total of all active and inactive participants2020-07-01137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-07-010
Total participants2020-07-01137
Number of participants with account balances2020-07-01119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-07-016
2019: 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2019 401k membership
Total participants, beginning-of-year2019-07-01130
Total number of active participants reported on line 7a of the Form 55002019-07-0195
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-0134
Total of all active and inactive participants2019-07-01129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-07-010
Total participants2019-07-01129
Number of participants with account balances2019-07-01115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-07-015
2018: 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2018 401k membership
Total participants, beginning-of-year2018-07-01128
Total number of active participants reported on line 7a of the Form 55002018-07-0195
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-0135
Total of all active and inactive participants2018-07-01130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-07-010
Total participants2018-07-01130
Number of participants with account balances2018-07-01107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-07-0116

Financial Data on 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME

Measure Date Value
2022 : 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$0
Total income from all sources (including contributions)2022-06-30$-745,490
Total loss/gain on sale of assets2022-06-30$0
Total of all expenses incurred2022-06-30$59,068
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$57,950
Expenses. Certain deemed distributions of participant loans2022-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$299,281
Value of total assets at end of year2022-06-30$6,240,594
Value of total assets at beginning of year2022-06-30$7,045,152
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$1,118
Total interest from all sources2022-06-30$4,512
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30No
Was this plan covered by a fidelity bond2022-06-30Yes
Value of fidelity bond cover2022-06-30$500,000
If this is an individual account plan, was there a blackout period2022-06-30No
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$178,638
Income. Received or receivable in cash from other sources (including rollovers)2022-06-30$0
Administrative expenses (other) incurred2022-06-30$1,118
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Value of net income/loss2022-06-30$-804,558
Value of net assets at end of year (total assets less liabilities)2022-06-30$6,240,594
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$7,045,152
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-06-30$5,485,837
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-06-30$6,344,555
Interest on participant loans2022-06-30$0
Interest earned on other investments2022-06-30$4,512
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-06-30$754,757
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-06-30$700,597
Expenses. Payments to insurance carriers foe the provision of benefits2022-06-30$0
Net investment gain/loss from pooled separate accounts2022-06-30$-1,049,283
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30No
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Contributions received in cash from employer2022-06-30$120,643
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$57,950
Did the plan have assets held for investment2022-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30No
Opinion of an independent qualified public accountant for this plan2022-06-30Unqualified
Accountancy firm name2022-06-30LEONARD, MULHERIN & GREENE, P.C
Accountancy firm EIN2022-06-30043108635
2021 : 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$0
Total income from all sources (including contributions)2021-06-30$1,778,051
Total loss/gain on sale of assets2021-06-30$0
Total of all expenses incurred2021-06-30$159,040
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$157,938
Expenses. Certain deemed distributions of participant loans2021-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$297,566
Value of total assets at end of year2021-06-30$7,045,152
Value of total assets at beginning of year2021-06-30$5,426,141
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$1,102
Total interest from all sources2021-06-30$6,257
Total dividends received (eg from common stock, registered investment company shares)2021-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-06-30No
Was this plan covered by a fidelity bond2021-06-30Yes
Value of fidelity bond cover2021-06-30$500,000
If this is an individual account plan, was there a blackout period2021-06-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-06-30$0
Were there any nonexempt tranactions with any party-in-interest2021-06-30No
Contributions received from participants2021-06-30$166,708
Income. Received or receivable in cash from other sources (including rollovers)2021-06-30$0
Other income not declared elsewhere2021-06-30$0
Administrative expenses (other) incurred2021-06-30$1,102
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Value of net income/loss2021-06-30$1,619,011
Value of net assets at end of year (total assets less liabilities)2021-06-30$7,045,152
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$5,426,141
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
Were any leases to which the plan was party in default or uncollectible2021-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-06-30$6,344,555
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-06-30$4,802,511
Interest on participant loans2021-06-30$0
Interest earned on other investments2021-06-30$6,257
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-06-30$700,597
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-06-30$623,630
Expenses. Payments to insurance carriers foe the provision of benefits2021-06-30$0
Net investment gain/loss from pooled separate accounts2021-06-30$1,474,228
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-06-30No
Was there a failure to transmit to the plan any participant contributions2021-06-30No
Has the plan failed to provide any benefit when due under the plan2021-06-30No
Contributions received in cash from employer2021-06-30$130,858
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-06-30$157,938
Did the plan have assets held for investment2021-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-06-30No
Opinion of an independent qualified public accountant for this plan2021-06-30Disclaimer
Accountancy firm name2021-06-30LEONARD, MULHERIN & GREENE, P.C
Accountancy firm EIN2021-06-30043108635
2020 : 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$0
Total income from all sources (including contributions)2020-06-30$616,982
Total loss/gain on sale of assets2020-06-30$0
Total of all expenses incurred2020-06-30$320,438
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-06-30$319,335
Expenses. Certain deemed distributions of participant loans2020-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-06-30$311,732
Value of total assets at end of year2020-06-30$5,426,141
Value of total assets at beginning of year2020-06-30$5,129,597
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-06-30$1,103
Total interest from all sources2020-06-30$9,148
Total dividends received (eg from common stock, registered investment company shares)2020-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-06-30No
Was this plan covered by a fidelity bond2020-06-30Yes
Value of fidelity bond cover2020-06-30$500,000
If this is an individual account plan, was there a blackout period2020-06-30No
Were there any nonexempt tranactions with any party-in-interest2020-06-30No
Contributions received from participants2020-06-30$177,230
Participant contributions at end of year2020-06-30$0
Participant contributions at beginning of year2020-06-30$6,760
Income. Received or receivable in cash from other sources (including rollovers)2020-06-30$0
Other income not declared elsewhere2020-06-30$0
Administrative expenses (other) incurred2020-06-30$1,103
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Value of net income/loss2020-06-30$296,544
Value of net assets at end of year (total assets less liabilities)2020-06-30$5,426,141
Value of net assets at beginning of year (total assets less liabilities)2020-06-30$5,129,597
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-06-30No
Were any leases to which the plan was party in default or uncollectible2020-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-06-30$4,802,511
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-06-30$4,429,334
Interest on participant loans2020-06-30$0
Interest earned on other investments2020-06-30$9,148
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-06-30$623,630
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-06-30$688,595
Expenses. Payments to insurance carriers foe the provision of benefits2020-06-30$0
Net investment gain/loss from pooled separate accounts2020-06-30$296,102
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-06-30No
Was there a failure to transmit to the plan any participant contributions2020-06-30No
Has the plan failed to provide any benefit when due under the plan2020-06-30No
Contributions received in cash from employer2020-06-30$134,502
Employer contributions (assets) at end of year2020-06-30$0
Employer contributions (assets) at beginning of year2020-06-30$4,908
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-06-30$319,335
Did the plan have assets held for investment2020-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-06-30Yes
Opinion of an independent qualified public accountant for this plan2020-06-30Disclaimer
Accountancy firm name2020-06-30LEONARD, MULHERIN & GREENE, P.C.
Accountancy firm EIN2020-06-30043108635
2019 : 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total income from all sources (including contributions)2019-06-30$535,609
Total loss/gain on sale of assets2019-06-30$0
Total of all expenses incurred2019-06-30$69,226
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$68,059
Expenses. Certain deemed distributions of participant loans2019-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$290,386
Value of total assets at end of year2019-06-30$5,129,597
Value of total assets at beginning of year2019-06-30$4,663,214
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$1,167
Total interest from all sources2019-06-30$9,184
Total dividends received (eg from common stock, registered investment company shares)2019-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30No
Was this plan covered by a fidelity bond2019-06-30Yes
Value of fidelity bond cover2019-06-30$500,000
If this is an individual account plan, was there a blackout period2019-06-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-06-30$0
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Contributions received from participants2019-06-30$165,432
Participant contributions at end of year2019-06-30$6,760
Participant contributions at beginning of year2019-06-30$5,892
Income. Received or receivable in cash from other sources (including rollovers)2019-06-30$0
Other income not declared elsewhere2019-06-30$0
Administrative expenses (other) incurred2019-06-30$1,167
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Value of net income/loss2019-06-30$466,383
Value of net assets at end of year (total assets less liabilities)2019-06-30$5,129,597
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$4,663,214
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-06-30$4,429,334
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-06-30$4,019,718
Interest on participant loans2019-06-30$0
Interest earned on other investments2019-06-30$9,184
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-06-30$688,595
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-06-30$632,526
Expenses. Payments to insurance carriers foe the provision of benefits2019-06-30$0
Net investment gain/loss from pooled separate accounts2019-06-30$236,039
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30No
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Contributions received in cash from employer2019-06-30$124,954
Employer contributions (assets) at end of year2019-06-30$4,908
Employer contributions (assets) at beginning of year2019-06-30$5,078
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-06-30$68,059
Did the plan have assets held for investment2019-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-06-30Yes
Opinion of an independent qualified public accountant for this plan2019-06-30Disclaimer
Accountancy firm name2019-06-30LEONARD, MULHERIN & GREENE, P.C.
Accountancy firm EIN2019-06-30043108635

Form 5500 Responses for 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME

2021: 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: 403(B) THRIFT PLAN OF FALL RIVER DEACONESS HOME 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number015325D
Policy instance 1
Insurance contract or identification number015325D
Number of Individuals Covered136
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $683
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 planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $0
Amount paid for insurance broker fees683
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number015325D
Policy instance 1
Insurance contract or identification number015325D
Number of Individuals Covered120
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $683
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 planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $0
Amount paid for insurance broker fees683
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number015325D
Policy instance 1
Insurance contract or identification number015325D
Number of Individuals Covered115
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,090
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 planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $0
Amount paid for insurance broker fees1090
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number015325D
Policy instance 1
Insurance contract or identification number015325D
Number of Individuals Covered107
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,149
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 planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $0
Amount paid for insurance broker fees1149
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3

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