401k Plan data: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. plan

EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 401k Plan overview

Plan Name	EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC.
Plan identification number	001

EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 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.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

KNOX AREA RESCUE MINISTRIES, INC. has sponsored the creation of one or more 401k plans.

Company Name: KNOX AREA RESCUE MINISTRIES, INC.

Employer identification number (EIN): 620670972

NAIC Classification: 624200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 DANITA MCCARTNEY 2023-06-07
001 2021-01-01 BURT ROSEN 2022-07-21
001 2020-01-01 BURT ROSEN 2021-07-09
001 2019-01-01 BURT ROSEN 2020-04-14
001 2018-01-01 BURT ROSEN 2019-06-17
001 2017-01-01 BURT ROSEN 2018-06-19
001 2016-01-01 BURT ROSEN 2017-05-26
001 2015-01-01 BURT ROSEN
001 2014-01-01
001 2013-01-01
001 2012-01-01 BURT ROSEN 2013-10-14
001 2011-01-01 BURT ROSEN 2012-10-11
001 2010-01-01 BURT ROSEN
001 2009-01-01 BURT ROSEN
001 2009-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	DANITA MCCARTNEY	2023-06-07
001	2021-01-01	BURT ROSEN	2022-07-21
001	2020-01-01	BURT ROSEN	2021-07-09
001	2019-01-01	BURT ROSEN	2020-04-14
001	2018-01-01	BURT ROSEN	2019-06-17
001	2017-01-01	BURT ROSEN	2018-06-19
001	2016-01-01	BURT ROSEN	2017-05-26
001	2015-01-01	BURT ROSEN
001	2014-01-01
001	2013-01-01
001	2012-01-01	BURT ROSEN	2013-10-14
001	2011-01-01	BURT ROSEN	2012-10-11
001	2010-01-01	BURT ROSEN
001	2009-01-01	BURT ROSEN
001	2009-01-01

Plan Statistics for EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC.

401k plan membership statisitcs for EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC.

Measure Date Value
2015: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 72
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 74
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 11
Total of all active and inactive participants 2015-01-01 85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 85
Number of participants with account balances 2015-01-01 47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 35
Number of retired or separated participants receiving benefits 2014-01-01 11
Total of all active and inactive participants 2014-01-01 46
Total participants 2014-01-01 46
Number of participants with account balances 2014-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1
2013: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 157
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 124
Number of retired or separated participants receiving benefits 2013-01-01 7
Total of all active and inactive participants 2013-01-01 131
Total participants 2013-01-01 131
Number of participants with account balances 2013-01-01 35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2010: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2010 401k membership
Total participants, beginning-of-year 2010-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 118
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 0
Total of all active and inactive participants 2010-01-01 118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 118
Number of participants with account balances 2010-01-01 47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 5
2009: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2009 401k membership
Total participants, beginning-of-year 2009-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 107
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 18
Total of all active and inactive participants 2009-01-01 125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 125
Number of participants with account balances 2009-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2015: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	72
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	74
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	11
Total of all active and inactive participants	2015-01-01	85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	85
Number of participants with account balances	2015-01-01	47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	35
Number of retired or separated participants receiving benefits	2014-01-01	11
Total of all active and inactive participants	2014-01-01	46
Total participants	2014-01-01	46
Number of participants with account balances	2014-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1
2013: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	157
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	124
Number of retired or separated participants receiving benefits	2013-01-01	7
Total of all active and inactive participants	2013-01-01	131
Total participants	2013-01-01	131
Number of participants with account balances	2013-01-01	35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2010: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2010 401k membership
Total participants, beginning-of-year	2010-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	118
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	0
Total of all active and inactive participants	2010-01-01	118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	118
Number of participants with account balances	2010-01-01	47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	5
2009: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2009 401k membership
Total participants, beginning-of-year	2009-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	107
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	18
Total of all active and inactive participants	2009-01-01	125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	125
Number of participants with account balances	2009-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC.

Measure	Date	Value
2015 : EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2015 401k financial data
Total income from all sources	2015-12-31	$138,864
Expenses. Total of all expenses incurred	2015-12-31	$240,024
Benefits paid (including direct rollovers)	2015-12-31	$239,511
Total plan assets at end of year	2015-12-31	$716,299
Total plan assets at beginning of year	2015-12-31	$817,459
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$79,038
Expenses. Other expenses not covered elsewhere	2015-12-31	$513
Contributions received from other sources (not participants or employers)	2015-12-31	$38,704
Other income received	2015-12-31	$-30,074
Net income (gross income less expenses)	2015-12-31	$-101,160
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$716,299
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$817,459
Total contributions received or receivable from employer(s)	2015-12-31	$51,196
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2014 401k financial data
Total income from all sources (including contributions)	2014-12-31	$132,553
Total of all expenses incurred	2014-12-31	$43,820
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$43,612
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$92,939
Value of total assets at end of year	2014-12-31	$817,458
Value of total assets at beginning of year	2014-12-31	$728,725
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$208
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$47,058
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$17,815
Administrative expenses (other) incurred	2014-12-31	$208
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$88,733
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$817,458
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$728,725
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$817,458
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$728,725
Net investment gain/loss from pooled separate accounts	2014-12-31	$39,614
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$28,066
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$43,612
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2014-12-31	No
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	COULTER & JUSTUS, P.C.
Accountancy firm EIN	2014-12-31	621532536
2013 : EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$214,987
Total of all expenses incurred	2013-12-31	$89,064
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$88,816
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$95,170
Value of total assets at end of year	2013-12-31	$728,725
Value of total assets at beginning of year	2013-12-31	$602,802
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$248
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	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$49,588
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$19,014
Administrative expenses (other) incurred	2013-12-31	$248
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	$125,923
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$728,725
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$602,802
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	$728,725
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$602,802
Net investment gain/loss from pooled separate accounts	2013-12-31	$119,817
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	$26,568
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$88,816
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
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	COULTER & JUSTUS, P.C.
Accountancy firm EIN	2013-12-31	621532536
2010 : EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$357,051
Expenses. Total of all expenses incurred	2010-12-31	$4,103
Benefits paid (including direct rollovers)	2010-12-31	$983
Total plan assets at end of year	2010-12-31	$352,948
Total plan assets at beginning of year	2010-12-31	$246,755
Value of fidelity bond covering the plan	2010-12-31	$500,000
Total contributions received or receivable from participants	2010-12-31	$34,729
Expenses. Other expenses not covered elsewhere	2010-12-31	$3,120
Contributions received from other sources (not participants or employers)	2010-12-31	$104,650
Other income received	2010-12-31	$202,206
Net income (gross income less expenses)	2010-12-31	$352,948
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$352,948
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$246,755
Total contributions received or receivable from employer(s)	2010-12-31	$15,466
Value of certain deemed distributions of participant loans	2010-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 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

Form 5500 Responses for EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC.

2015: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 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 funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, 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 funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2010: EMPLOYEE BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	First time form 5500 has been submitted	Yes
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 BENEFIT PLAN OF KNOX AREA RESCUE MINISTRIES, INC. 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

058129-J

Policy instance

Insurance contract or identification number	058129-J
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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?	Yes

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

Policy contract number

058129-J

Policy instance

Insurance contract or identification number	058129-J
Number of Individuals Covered	44
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $123
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
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 $123
Insurance broker organization code?	3
Insurance broker name	NASHVILLE REGIONAL OFFICE

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

Policy contract number

058129-J

Policy instance

Insurance contract or identification number	058129-J
Number of Individuals Covered	35
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $225
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
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 $225
Insurance broker organization code?	3
Insurance broker name	NASHVILLE REGIONAL OFFICE

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

Policy contract number

058129J

Policy instance

Insurance contract or identification number	058129J
Number of Individuals Covered	47
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 $0
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:	KNOX AREA RESCUE MINISTRIES, INC.
Employer identification number (EIN):	620670972
NAIC Classification:	624200