401k Plan data: 403(B) THRIFT PLAN plan

403(B) THRIFT PLAN 401k Plan overview

Plan Name	403(B) THRIFT PLAN
Plan identification number	002

403(B) THRIFT PLAN Benefits

401k Plan Type

Defined 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.
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.

401k Sponsoring company profile

BIG BROTHERS BIG SISTERS OF GREATER CLEVELAND has sponsored the creation of one or more 401k plans.

Company Name: BIG BROTHERS BIG SISTERS OF GREATER CLEVELAND

Employer identification number (EIN): 341039700

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Additional information about BIG BROTHERS BIG SISTERS OF GREATER CLEVELAND

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1992-03-17

Company Identification Number: 817671

Legal Registered Office Address: 4614 PROSPECT AVENUE, SUITE 410
-
CLEVELAND
United States of America (USA)
44103

More information about BIG BROTHERS BIG SISTERS OF GREATER CLEVELAND

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 403(B) THRIFT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2017-01-01 ADRIANNE SIMS 2017-09-13 ADRIANNE SIMS 2017-09-13
002 2016-01-01 ADRIANNE SIMS 2017-09-13 ADRIANNE SIMS 2017-09-13
002 2015-01-01 PAULA BEATREZ PAULA BEATREZ, VICE PRESIDENT 2016-07-27
002 2014-01-01 PAULA BEATREZ PAULA BEATREZ, VICE PRESIDENT 2015-07-28
002 2013-01-01 PAULA BEATREZ PAULA BEATREZ, VICE PRESIDENT 2014-06-27
002 2012-01-01 PAULA BEATREZ PAULA BEATREZ, VICE PRESIDENT 2013-07-19
002 2011-01-01 PAULA BEATREZ PAULA BEATREZ, VICE PRESIDENT 2012-07-30
002 2010-01-01 PAULA BEATREZ PAULA BEATREZ, VICE PRESIDENT 2011-07-19
002 2009-01-01 PAULA BEATREZ PAULA BEATREZ, VICE PRESIDENT 2010-10-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2017-01-01	ADRIANNE SIMS	2017-09-13	ADRIANNE SIMS	2017-09-13
002	2016-01-01	ADRIANNE SIMS	2017-09-13	ADRIANNE SIMS	2017-09-13
002	2015-01-01	PAULA BEATREZ		PAULA BEATREZ, VICE PRESIDENT	2016-07-27
002	2014-01-01	PAULA BEATREZ		PAULA BEATREZ, VICE PRESIDENT	2015-07-28
002	2013-01-01	PAULA BEATREZ		PAULA BEATREZ, VICE PRESIDENT	2014-06-27
002	2012-01-01	PAULA BEATREZ		PAULA BEATREZ, VICE PRESIDENT	2013-07-19
002	2011-01-01	PAULA BEATREZ		PAULA BEATREZ, VICE PRESIDENT	2012-07-30
002	2010-01-01	PAULA BEATREZ		PAULA BEATREZ, VICE PRESIDENT	2011-07-19
002	2009-01-01	PAULA BEATREZ		PAULA BEATREZ, VICE PRESIDENT	2010-10-07

Plan Statistics for 403(B) THRIFT PLAN

401k plan membership statisitcs for 403(B) THRIFT PLAN

Measure Date Value
2015: 403(B) THRIFT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 2
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 9
Total of all active and inactive participants 2015-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 11
Number of participants with account balances 2015-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 1
2014: 403(B) THRIFT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 4
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 8
Total of all active and inactive participants 2014-01-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 12
Number of participants with account balances 2014-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 3
2013: 403(B) THRIFT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 7
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 8
Total of all active and inactive participants 2013-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 15
Number of participants with account balances 2013-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2012: 403(B) THRIFT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 9
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 6
Total of all active and inactive participants 2012-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 15
Number of participants with account balances 2012-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: 403(B) THRIFT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 12
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 5
Total of all active and inactive participants 2011-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 17
Number of participants with account balances 2011-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: 403(B) THRIFT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 4
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 6
Total of all active and inactive participants 2010-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 10
Number of participants with account balances 2010-01-01 10
2009: 403(B) THRIFT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 6
Total of all active and inactive participants 2009-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 8
Number of participants with account balances 2009-01-01 8

Measure	Date	Value
2015: 403(B) THRIFT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	2
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	9
Total of all active and inactive participants	2015-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	11
Number of participants with account balances	2015-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	1
2014: 403(B) THRIFT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	4
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	8
Total of all active and inactive participants	2014-01-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	12
Number of participants with account balances	2014-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	3
2013: 403(B) THRIFT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	7
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	8
Total of all active and inactive participants	2013-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	15
Number of participants with account balances	2013-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2012: 403(B) THRIFT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	9
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	6
Total of all active and inactive participants	2012-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	15
Number of participants with account balances	2012-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: 403(B) THRIFT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	12
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	5
Total of all active and inactive participants	2011-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	17
Number of participants with account balances	2011-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: 403(B) THRIFT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	4
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	6
Total of all active and inactive participants	2010-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	10
Number of participants with account balances	2010-01-01	10
2009: 403(B) THRIFT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	6
Total of all active and inactive participants	2009-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	8
Number of participants with account balances	2009-01-01	8

Financial Data on 403(B) THRIFT PLAN

Measure	Date	Value
2015 : 403(B) THRIFT PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$11,289
Expenses. Total of all expenses incurred	2015-12-31	$18,299
Benefits paid (including direct rollovers)	2015-12-31	$14,619
Total plan assets at end of year	2015-12-31	$158,141
Total plan assets at beginning of year	2015-12-31	$165,151
Value of fidelity bond covering the plan	2015-12-31	$25,000
Total contributions received or receivable from participants	2015-12-31	$9,484
Expenses. Other expenses not covered elsewhere	2015-12-31	$3,434
Other income received	2015-12-31	$-2,117
Net income (gross income less expenses)	2015-12-31	$-7,010
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$158,141
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$165,151
Total contributions received or receivable from employer(s)	2015-12-31	$3,922
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$246
Funding deficiency by the employer to the plan for this plan year	2015-12-31	$0
Minimum employer required contribution for this plan year	2015-12-31	$3,922
Amount contributed by the employer to the plan for this plan year	2015-12-31	$3,922
2014 : 403(B) THRIFT PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$53,005
Expenses. Total of all expenses incurred	2014-12-31	$72,846
Benefits paid (including direct rollovers)	2014-12-31	$72,628
Total plan assets at end of year	2014-12-31	$165,151
Total plan assets at beginning of year	2014-12-31	$184,992
Value of fidelity bond covering the plan	2014-12-31	$25,000
Total contributions received or receivable from participants	2014-12-31	$10,637
Contributions received from other sources (not participants or employers)	2014-12-31	$24,592
Other income received	2014-12-31	$11,499
Net income (gross income less expenses)	2014-12-31	$-19,841
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$165,151
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$184,992
Total contributions received or receivable from employer(s)	2014-12-31	$6,277
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$218
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$6,277
Amount contributed by the employer to the plan for this plan year	2014-12-31	$6,277
2013 : 403(B) THRIFT PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$62,380
Expenses. Total of all expenses incurred	2013-12-31	$2,877
Benefits paid (including direct rollovers)	2013-12-31	$2,669
Total plan assets at end of year	2013-12-31	$184,992
Total plan assets at beginning of year	2013-12-31	$125,489
Value of fidelity bond covering the plan	2013-12-31	$25,000
Total contributions received or receivable from participants	2013-12-31	$18,551
Expenses. Other expenses not covered elsewhere	2013-12-31	$208
Other income received	2013-12-31	$31,328
Net income (gross income less expenses)	2013-12-31	$59,503
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$184,992
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$125,489
Total contributions received or receivable from employer(s)	2013-12-31	$12,501
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$12,502
Amount contributed by the employer to the plan for this plan year	2013-12-31	$12,502
2012 : 403(B) THRIFT PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$44,946
Expenses. Total of all expenses incurred	2012-12-31	$4,128
Total plan assets at end of year	2012-12-31	$125,489
Total plan assets at beginning of year	2012-12-31	$84,671
Value of fidelity bond covering the plan	2012-12-31	$25,000
Total contributions received or receivable from participants	2012-12-31	$20,766
Expenses. Other expenses not covered elsewhere	2012-12-31	$1,812
Other income received	2012-12-31	$11,469
Net income (gross income less expenses)	2012-12-31	$40,818
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$125,489
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$84,671
Total contributions received or receivable from employer(s)	2012-12-31	$12,711
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$2,316
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$12,711
Amount contributed by the employer to the plan for this plan year	2012-12-31	$12,711
2011 : 403(B) THRIFT PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$59,079
Expenses. Total of all expenses incurred	2011-12-31	$18,101
Benefits paid (including direct rollovers)	2011-12-31	$16,921
Total plan assets at end of year	2011-12-31	$84,671
Total plan assets at beginning of year	2011-12-31	$43,693
Value of fidelity bond covering the plan	2011-12-31	$25,000
Total contributions received or receivable from participants	2011-12-31	$20,716
Expenses. Other expenses not covered elsewhere	2011-12-31	$990
Contributions received from other sources (not participants or employers)	2011-12-31	$29,823
Other income received	2011-12-31	$-882
Net income (gross income less expenses)	2011-12-31	$40,978
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$84,671
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$43,693
Total contributions received or receivable from employer(s)	2011-12-31	$9,422
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$190
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$9,422
Amount contributed by the employer to the plan for this plan year	2011-12-31	$9,422
2010 : 403(B) THRIFT PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$15,212
Expenses. Total of all expenses incurred	2010-12-31	$4,549
Benefits paid (including direct rollovers)	2010-12-31	$4,460
Total plan assets at end of year	2010-12-31	$43,693
Total plan assets at beginning of year	2010-12-31	$33,030
Value of fidelity bond covering the plan	2010-12-31	$25,000
Total contributions received or receivable from participants	2010-12-31	$10,000
Other income received	2010-12-31	$5,212
Net income (gross income less expenses)	2010-12-31	$10,663
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$43,693
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$33,030
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$89

Form 5500 Responses for 403(B) THRIFT PLAN

2015: 403(B) THRIFT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: 403(B) THRIFT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: 403(B) THRIFT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: 403(B) THRIFT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: 403(B) THRIFT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: 403(B) THRIFT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: 403(B) THRIFT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

053120-K

Policy instance

Insurance contract or identification number	053120-K
Number of Individuals Covered	12
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of fees paid to insurance company	USD $24
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	24
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	AKRON REGIONAL OFFICE

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

Policy contract number

053120-K

Policy instance

Insurance contract or identification number	053120-K
Number of Individuals Covered	12
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of fees paid to insurance company	USD $23
Contracts With Unallocated Funds Deposit Administration	1
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	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	AKRON REGIONAL OFFICE

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

Policy contract number

053120-K

Policy instance

Insurance contract or identification number	053120-K
Number of Individuals Covered	15
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $36
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	36
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	AKRON REGIONAL OFFICE

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

Policy contract number

053120-K

Policy instance

Insurance contract or identification number	053120-K
Number of Individuals Covered	15
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $65
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	JASON HICAR

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

Policy contract number

053120-K

Policy instance

Insurance contract or identification number	053120-K
Number of Individuals Covered	17
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of fees paid to insurance company	USD $38
Contracts With Unallocated Funds Deposit Administration	1
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

053120-K

Policy instance

Insurance contract or identification number	053120-K
Number of Individuals Covered	10
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of fees paid to insurance company	USD $6
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BRENT TEAGUE

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Company Name:	BIG BROTHERS BIG SISTERS OF GREATER CLEVELAND
Employer identification number (EIN):	341039700
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1992-03-17
Company Identification Number:	817671
Legal Registered Office Address:	4614 PROSPECT AVENUE, SUITE 410 - CLEVELAND United States of America (USA) 44103