401k Plan data: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE plan

EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 401k Plan overview

Plan Name	EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE
Plan identification number	002

EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

PROFESSIONAL EXAMINATION SERVICE has sponsored the creation of one or more 401k plans.

Company Name: PROFESSIONAL EXAMINATION SERVICE

Employer identification number (EIN): 237097173

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01 SANDRA LOGORDA 2019-08-29 SANDRA LOGORDA 2019-08-29
002 2017-01-01 SANDRA LOGORDA 2018-06-13 SANDRA LOGORDA 2018-06-13
002 2016-01-01 SANDRA LOGORDA 2017-06-27 SANDRA LOGORDA 2017-06-27
002 2015-01-01 SANDRA LOGORDA 2016-06-23 SANDRA LOGORDA 2016-06-23
002 2014-01-01 SANDRA LOGORDA 2015-07-09 SANDRA LOGORDA 2015-07-09
002 2013-01-01 SANDRA LOGORDA 2014-08-18 SANDRA LOGORDA 2014-08-18
002 2012-01-01 SANDRA LOGORDA 2013-08-02
002 2011-01-01 JEFFREY P. MOHN 2012-10-12 MAUREEN TILLWITZ 2012-10-15
002 2010-01-01 MAUREEN TILLWITZ JEFFERY P. MOHN 2011-10-12
002 2009-01-01 MAUREEN TILLWITZ JEFFERY P. MOHN 2010-09-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01	SANDRA LOGORDA	2019-08-29	SANDRA LOGORDA	2019-08-29
002	2017-01-01	SANDRA LOGORDA	2018-06-13	SANDRA LOGORDA	2018-06-13
002	2016-01-01	SANDRA LOGORDA	2017-06-27	SANDRA LOGORDA	2017-06-27
002	2015-01-01	SANDRA LOGORDA	2016-06-23	SANDRA LOGORDA	2016-06-23
002	2014-01-01	SANDRA LOGORDA	2015-07-09	SANDRA LOGORDA	2015-07-09
002	2013-01-01	SANDRA LOGORDA	2014-08-18	SANDRA LOGORDA	2014-08-18
002	2012-01-01	SANDRA LOGORDA	2013-08-02
002	2011-01-01	JEFFREY P. MOHN	2012-10-12	MAUREEN TILLWITZ	2012-10-15
002	2010-01-01	MAUREEN TILLWITZ		JEFFERY P. MOHN	2011-10-12
002	2009-01-01	MAUREEN TILLWITZ		JEFFERY P. MOHN	2010-09-29

Plan Statistics for EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE

401k plan membership statisitcs for EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE

Measure Date Value
2021: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2021 401k membership
Total participants, beginning-of-year 2021-01-01 49
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 6
Number of retired or separated participants receiving benefits 2021-01-01 4
Number of other retired or separated participants entitled to future benefits 2021-01-01 37
Total of all active and inactive participants 2021-01-01 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 47
Number of participants with account balances 2021-01-01 47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2020 401k membership
Total participants, beginning-of-year 2020-01-01 57
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 6
Number of retired or separated participants receiving benefits 2020-01-01 4
Number of other retired or separated participants entitled to future benefits 2020-01-01 39
Total of all active and inactive participants 2020-01-01 49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 49
Number of participants with account balances 2020-01-01 49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2019 401k membership
Total participants, beginning-of-year 2019-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 16
Number of retired or separated participants receiving benefits 2019-01-01 4
Number of other retired or separated participants entitled to future benefits 2019-01-01 37
Total of all active and inactive participants 2019-01-01 57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 57
Number of participants with account balances 2019-01-01 57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2010: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2010 401k membership
Total participants, beginning-of-year 2010-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 79
Number of retired or separated participants receiving benefits 2010-01-01 1
Number of other retired or separated participants entitled to future benefits 2010-01-01 25
Total of all active and inactive participants 2010-01-01 105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 105
Number of participants with account balances 2010-01-01 105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 1
2009: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2009 401k membership
Total participants, beginning-of-year 2009-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 88
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 23
Total of all active and inactive participants 2009-01-01 112
Total participants 2009-01-01 112
Number of participants with account balances 2009-01-01 112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2021: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2021 401k membership
Total participants, beginning-of-year	2021-01-01	49
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	6
Number of retired or separated participants receiving benefits	2021-01-01	4
Number of other retired or separated participants entitled to future benefits	2021-01-01	37
Total of all active and inactive participants	2021-01-01	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	47
Number of participants with account balances	2021-01-01	47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2020 401k membership
Total participants, beginning-of-year	2020-01-01	57
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	6
Number of retired or separated participants receiving benefits	2020-01-01	4
Number of other retired or separated participants entitled to future benefits	2020-01-01	39
Total of all active and inactive participants	2020-01-01	49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	49
Number of participants with account balances	2020-01-01	49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2019 401k membership
Total participants, beginning-of-year	2019-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	16
Number of retired or separated participants receiving benefits	2019-01-01	4
Number of other retired or separated participants entitled to future benefits	2019-01-01	37
Total of all active and inactive participants	2019-01-01	57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	57
Number of participants with account balances	2019-01-01	57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2010: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2010 401k membership
Total participants, beginning-of-year	2010-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	79
Number of retired or separated participants receiving benefits	2010-01-01	1
Number of other retired or separated participants entitled to future benefits	2010-01-01	25
Total of all active and inactive participants	2010-01-01	105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	105
Number of participants with account balances	2010-01-01	105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	1
2009: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2009 401k membership
Total participants, beginning-of-year	2009-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	88
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	23
Total of all active and inactive participants	2009-01-01	112
Total participants	2009-01-01	112
Number of participants with account balances	2009-01-01	112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE

Measure	Date	Value
2021 : EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2021 401k financial data
Total income from all sources	2021-12-31	$412,223
Expenses. Total of all expenses incurred	2021-12-31	$134,884
Benefits paid (including direct rollovers)	2021-12-31	$132,518
Total plan assets at end of year	2021-12-31	$3,940,613
Total plan assets at beginning of year	2021-12-31	$3,663,274
Total contributions received or receivable from participants	2021-12-31	$0
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$412,223
Net income (gross income less expenses)	2021-12-31	$277,339
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$3,940,613
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$3,663,274
Total contributions received or receivable from employer(s)	2021-12-31	$0
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$2,366
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
2020 : EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2020 401k financial data
Total income from all sources	2020-12-31	$486,914
Expenses. Total of all expenses incurred	2020-12-31	$884,397
Benefits paid (including direct rollovers)	2020-12-31	$870,180
Total plan assets at end of year	2020-12-31	$3,663,274
Total plan assets at beginning of year	2020-12-31	$4,060,757
Value of fidelity bond covering the plan	2020-12-31	$1,000,000
Total contributions received or receivable from participants	2020-12-31	$0
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$476,895
Net income (gross income less expenses)	2020-12-31	$-397,483
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$3,663,274
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$4,060,757
Total contributions received or receivable from employer(s)	2020-12-31	$10,019
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$14,217
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2019 401k financial data
Total income from all sources	2019-12-31	$704,082
Expenses. Total of all expenses incurred	2019-12-31	$292,478
Benefits paid (including direct rollovers)	2019-12-31	$290,196
Total plan assets at end of year	2019-12-31	$4,060,757
Total plan assets at beginning of year	2019-12-31	$3,649,153
Value of fidelity bond covering the plan	2019-12-31	$1,000,000
Total contributions received or receivable from participants	2019-12-31	$0
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$644,554
Net income (gross income less expenses)	2019-12-31	$411,604
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$4,060,757
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$3,649,153
Total contributions received or receivable from employer(s)	2019-12-31	$59,528
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$2,282
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2010 : EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2010 401k financial data
Total income from all sources	2010-12-31	$650,931
Expenses. Total of all expenses incurred	2010-12-31	$184,302
Benefits paid (including direct rollovers)	2010-12-31	$184,202
Total plan assets at end of year	2010-12-31	$4,390,109
Total plan assets at beginning of year	2010-12-31	$3,923,480
Value of fidelity bond covering the plan	2010-12-31	$1,000,000
Contributions received from other sources (not participants or employers)	2010-12-31	$14,761
Other income received	2010-12-31	$367,922
Net income (gross income less expenses)	2010-12-31	$466,629
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$4,390,109
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$3,923,480
Total contributions received or receivable from employer(s)	2010-12-31	$268,248
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$100
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$268,248
Amount contributed by the employer to the plan for this plan year	2010-12-31	$268,248
2009 : EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$298,070
Amount contributed by the employer to the plan for this plan year	2009-12-31	$298,070

Form 5500 Responses for EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE

2021: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 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: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 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: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 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
2010: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: EMPLOYEE BENEFITS PLAN OF PROFESSIONAL EXAMINATION SERVICE 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

MR 61042

Policy instance

Insurance contract or identification number	MR 61042
Number of Individuals Covered	47
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

MR 61042

Policy instance

Insurance contract or identification number	MR 61042
Number of Individuals Covered	49
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

MR 61042

Policy instance

Insurance contract or identification number	MR 61042
Number of Individuals Covered	57
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

051090G

Policy instance

Insurance contract or identification number	051090G
Number of Individuals Covered	105
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $526
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	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

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Company Name:	PROFESSIONAL EXAMINATION SERVICE
Employer identification number (EIN):	237097173
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services