401k Plan data: 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. plan

403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 401k Plan overview

Plan Name	403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC.
Plan identification number	003

403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.

401k Sponsoring company profile

CHARLEE OF DADE COUNTY, INC. has sponsored the creation of one or more 401k plans.

Company Name: CHARLEE OF DADE COUNTY, INC.

Employer identification number (EIN): 592302250

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about CHARLEE OF DADE COUNTY, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1983-02-17

Company Identification Number: 767049

Legal Registered Office Address: CHARLEE OF DADE COUNTY, INC.

MIAMI

33130

More information about CHARLEE OF DADE COUNTY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2015-01-01 LISSA GUILLARD 2016-06-29 LISSA GUILLARD 2016-06-29
003 2014-01-01 LISSA GUILLARD 2015-10-15 LISSA GUILLARD 2015-10-15
003 2013-01-01 SUZY SCHUMER
003 2012-01-01 SUZY SCHUMER
003 2011-01-01 SUZY SCHUMER
003 2009-01-01 SUZY SCHUMER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2015-01-01	LISSA GUILLARD	2016-06-29	LISSA GUILLARD	2016-06-29
003	2014-01-01	LISSA GUILLARD	2015-10-15	LISSA GUILLARD	2015-10-15
003	2013-01-01	SUZY SCHUMER
003	2012-01-01	SUZY SCHUMER
003	2011-01-01	SUZY SCHUMER
003	2009-01-01	SUZY SCHUMER

Plan Statistics for 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC.

401k plan membership statisitcs for 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC.

Measure Date Value
2013: 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 65
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 54
Total of all active and inactive participants 2013-01-01 119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 119
Number of participants with account balances 2013-01-01 119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 9
2012: 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2012 401k membership
Total participants, beginning-of-year 2012-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 76
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 55
Total of all active and inactive participants 2012-01-01 131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 131
Number of participants with account balances 2012-01-01 131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2011 401k membership
Total participants, beginning-of-year 2011-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 71
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 51
Total of all active and inactive participants 2011-01-01 122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 122
Number of participants with account balances 2011-01-01 122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2009 401k membership
Total participants, beginning-of-year 2009-01-01 80
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 70
Number of other retired or separated participants entitled to future benefits 2009-01-01 24
Total of all active and inactive participants 2009-01-01 94
Total participants 2009-01-01 94
Number of participants with account balances 2009-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 3

Measure	Date	Value
2013: 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	65
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	54
Total of all active and inactive participants	2013-01-01	119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	119
Number of participants with account balances	2013-01-01	119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	9
2012: 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	76
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	55
Total of all active and inactive participants	2012-01-01	131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	131
Number of participants with account balances	2012-01-01	131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2011 401k membership
Total participants, beginning-of-year	2011-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	71
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	51
Total of all active and inactive participants	2011-01-01	122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	122
Number of participants with account balances	2011-01-01	122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2009 401k membership
Total participants, beginning-of-year	2009-01-01	80
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	70
Number of other retired or separated participants entitled to future benefits	2009-01-01	24
Total of all active and inactive participants	2009-01-01	94
Total participants	2009-01-01	94
Number of participants with account balances	2009-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	3

Financial Data on 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC.

Measure	Date	Value
2013 : 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$268,930
Total of all expenses incurred	2013-12-31	$470,874
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$470,657
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$97,764
Value of total assets at end of year	2013-12-31	$1,027,223
Value of total assets at beginning of year	2013-12-31	$1,229,167
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$217
Total interest from all sources	2013-12-31	$4,978
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$100,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$66,667
Participant contributions at end of year	2013-12-31	$59,483
Participant contributions at beginning of year	2013-12-31	$59,216
Participant contributions at end of year	2013-12-31	$3,427
Participant contributions at beginning of year	2013-12-31	$4,951
Administrative expenses (other) incurred	2013-12-31	$217
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-201,944
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$1,027,223
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,229,167
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$670,105
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$856,252
Interest earned on other investments	2013-12-31	$4,978
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$294,208
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$308,748
Net investment gain/loss from pooled separate accounts	2013-12-31	$166,188
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$31,097
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$470,657
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	VERDEJA & DE ARMAS, LLP
Accountancy firm EIN	2013-12-31	204989621
2012 : 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$231,217
Total of all expenses incurred	2012-12-31	$91,718
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$91,668
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$136,794
Value of total assets at end of year	2012-12-31	$1,229,167
Value of total assets at beginning of year	2012-12-31	$1,089,668
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$50
Total interest from all sources	2012-12-31	$6,468
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$100,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$101,573
Participant contributions at end of year	2012-12-31	$59,216
Participant contributions at beginning of year	2012-12-31	$44,384
Participant contributions at end of year	2012-12-31	$4,951
Participant contributions at beginning of year	2012-12-31	$5,814
Administrative expenses (other) incurred	2012-12-31	$50
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$139,499
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,229,167
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,089,668
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$856,252
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$746,805
Interest earned on other investments	2012-12-31	$6,468
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$308,748
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$292,665
Net investment gain/loss from pooled separate accounts	2012-12-31	$87,955
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$35,221
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$91,668
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	VERDEJA & DE ARMAS, LLP
Accountancy firm EIN	2012-12-31	204989621
2011 : 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$117,149
Total of all expenses incurred	2011-12-31	$71,356
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$69,810
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$136,050
Value of total assets at end of year	2011-12-31	$1,089,668
Value of total assets at beginning of year	2011-12-31	$1,043,875
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,546
Total interest from all sources	2011-12-31	$9,315
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$100,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$99,938
Participant contributions at end of year	2011-12-31	$44,384
Participant contributions at beginning of year	2011-12-31	$14,467
Participant contributions at end of year	2011-12-31	$5,814
Other income not declared elsewhere	2011-12-31	$723
Administrative expenses (other) incurred	2011-12-31	$1,546
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$45,793
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,089,668
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,043,875
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$746,805
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$606,386
Interest earned on other investments	2011-12-31	$9,315
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$292,665
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$423,022
Net investment gain/loss from pooled separate accounts	2011-12-31	$-28,939
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$36,112
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$69,810
Did the plan have assets held for investment	2011-12-31	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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	VERDEJA & DE ARMAS, LLP
Accountancy firm EIN	2011-12-31	204989621
2010 : 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$236,041
Total of all expenses incurred	2010-12-31	$62,583
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$62,483
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$134,361
Value of total assets at end of year	2010-12-31	$1,043,875
Value of total assets at beginning of year	2010-12-31	$870,417
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$100
Total interest from all sources	2010-12-31	$1
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$100,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$97,959
Participant contributions at end of year	2010-12-31	$14,467
Participant contributions at beginning of year	2010-12-31	$11,953
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$1,214
Administrative expenses (other) incurred	2010-12-31	$100
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$173,458
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,043,875
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$870,417
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$606,386
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$622,765
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$1
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$423,022
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$235,699
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$10,145
Net investment gain/loss from pooled separate accounts	2010-12-31	$91,534
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$35,188
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$62,483
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	VERDEJA & DE ARMAS, LLP
Accountancy firm EIN	2010-12-31	204989621

Form 5500 Responses for 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC.

2013: 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 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 OF CHARLEE OF DADE COUNTY, INC. 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 OF CHARLEE OF DADE COUNTY, INC. 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
2009: 403(B) THRIFT PLAN OF CHARLEE OF DADE COUNTY, INC. 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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

017680-A

Policy instance

Insurance contract or identification number	017680-A
Number of Individuals Covered	119
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $543
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	543
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WEST PALM BEACH REGIONAL OFFICE

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

Policy contract number

017680-A

Policy instance

Insurance contract or identification number	017680-A
Number of Individuals Covered	131
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $407
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	188
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	AMY EISINGER

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

Policy contract number

017680-A

Policy instance

Insurance contract or identification number	017680-A
Number of Individuals Covered	122
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of fees paid to insurance company	USD $432
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

017680-A

Policy instance

Insurance contract or identification number	017680-A
Number of Individuals Covered	119
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of fees paid to insurance company	USD $509
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	180
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MARJORIE BAKER

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Company Name:	CHARLEE OF DADE COUNTY, INC.
Employer identification number (EIN):	592302250
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1983-02-17
Company Identification Number:	767049
Legal Registered Office Address:	CHARLEE OF DADE COUNTY, INC. MIAMI 33130