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403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 401k Plan overview

Plan Name403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL
Plan identification number 001

403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

WASHITA VALLEY COMMUNITY ACTION COUNCIL has sponsored the creation of one or more 401k plans.

Company Name:WASHITA VALLEY COMMUNITY ACTION COUNCIL
Employer identification number (EIN):730776195
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012016-10-01SHARLOTTE KEY2018-04-05 SHARLOTTE KEY2018-04-05
0012015-10-01SHARLOTTE KEY SHARLOTTE KEY2017-04-25
0012014-10-01SHARLOTTE KEY SHARLOTTE KEY2016-03-08
0012013-10-01SHARLOTTE KEY SHARLOTTE KEY2015-04-28
0012012-10-01SHARLOTTE KEY SHARLOTTE KEY2014-07-15

Plan Statistics for 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL

401k plan membership statisitcs for 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL

Measure Date Value
2015: 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2015 401k membership
Total participants, beginning-of-year2015-10-0155
Total number of active participants reported on line 7a of the Form 55002015-10-0146
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-019
Total of all active and inactive participants2015-10-0155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-10-010
Total participants2015-10-0155
Number of participants with account balances2015-10-0155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-10-0114
2014: 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2014 401k membership
Total participants, beginning-of-year2014-10-0151
Total number of active participants reported on line 7a of the Form 55002014-10-0148
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-017
Total of all active and inactive participants2014-10-0155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-10-010
Total participants2014-10-0155
Number of participants with account balances2014-10-0155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-10-014
2013: 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2013 401k membership
Total participants, beginning-of-year2013-10-0136
Total number of active participants reported on line 7a of the Form 55002013-10-0148
Number of retired or separated participants receiving benefits2013-10-010
Number of other retired or separated participants entitled to future benefits2013-10-013
Total of all active and inactive participants2013-10-0151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-10-010
Total participants2013-10-0151
Number of participants with account balances2013-10-0151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-10-010
2012: 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2012 401k membership
Total participants, beginning-of-year2012-10-0163
Total number of active participants reported on line 7a of the Form 55002012-10-0135
Number of retired or separated participants receiving benefits2012-10-010
Number of other retired or separated participants entitled to future benefits2012-10-011
Total of all active and inactive participants2012-10-0136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-10-010
Total participants2012-10-0136
Number of participants with account balances2012-10-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-10-010

Financial Data on 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL

Measure Date Value
2016 : 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$0
Total income from all sources (including contributions)2016-09-30$150,323
Total loss/gain on sale of assets2016-09-30$0
Total of all expenses incurred2016-09-30$131,005
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-09-30$130,618
Expenses. Certain deemed distributions of participant loans2016-09-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-09-30$98,079
Value of total assets at end of year2016-09-30$907,515
Value of total assets at beginning of year2016-09-30$888,197
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-09-30$387
Total interest from all sources2016-09-30$3,432
Total dividends received (eg from common stock, registered investment company shares)2016-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-09-30No
Was this plan covered by a fidelity bond2016-09-30Yes
Value of fidelity bond cover2016-09-30$100,000
If this is an individual account plan, was there a blackout period2016-09-30No
Were there any nonexempt tranactions with any party-in-interest2016-09-30No
Contributions received from participants2016-09-30$51,770
Income. Received or receivable in cash from other sources (including rollovers)2016-09-30$0
Other income not declared elsewhere2016-09-30$3
Administrative expenses (other) incurred2016-09-30$387
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Value of net income/loss2016-09-30$19,318
Value of net assets at end of year (total assets less liabilities)2016-09-30$907,515
Value of net assets at beginning of year (total assets less liabilities)2016-09-30$888,197
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-09-30No
Were any leases to which the plan was party in default or uncollectible2016-09-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-09-30$553,585
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-09-30$607,157
Interest on participant loans2016-09-30$0
Interest earned on other investments2016-09-30$3,432
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-09-30$353,930
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-09-30$281,040
Expenses. Payments to insurance carriers foe the provision of benefits2016-09-30$0
Net investment gain/loss from pooled separate accounts2016-09-30$48,809
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-09-30No
Was there a failure to transmit to the plan any participant contributions2016-09-30No
Has the plan failed to provide any benefit when due under the plan2016-09-30No
Contributions received in cash from employer2016-09-30$46,309
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-09-30$130,618
Did the plan have assets held for investment2016-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-09-30Yes
Opinion of an independent qualified public accountant for this plan2016-09-30Disclaimer
Accountancy firm name2016-09-30SAUNDERS & ASSOCIATES, PLLC
Accountancy firm EIN2016-09-30208209116
2015 : 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$0
Total income from all sources (including contributions)2015-09-30$122,892
Total loss/gain on sale of assets2015-09-30$0
Total of all expenses incurred2015-09-30$121,752
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-09-30$121,632
Expenses. Certain deemed distributions of participant loans2015-09-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-09-30$119,589
Value of total assets at end of year2015-09-30$888,197
Value of total assets at beginning of year2015-09-30$887,057
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-09-30$120
Total interest from all sources2015-09-30$3,042
Total dividends received (eg from common stock, registered investment company shares)2015-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-09-30No
Was this plan covered by a fidelity bond2015-09-30Yes
Value of fidelity bond cover2015-09-30$150,000
If this is an individual account plan, was there a blackout period2015-09-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-09-30$0
Were there any nonexempt tranactions with any party-in-interest2015-09-30No
Contributions received from participants2015-09-30$61,813
Income. Received or receivable in cash from other sources (including rollovers)2015-09-30$0
Other income not declared elsewhere2015-09-30$0
Administrative expenses (other) incurred2015-09-30$120
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Value of net income/loss2015-09-30$1,140
Value of net assets at end of year (total assets less liabilities)2015-09-30$888,197
Value of net assets at beginning of year (total assets less liabilities)2015-09-30$887,057
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-09-30No
Were any leases to which the plan was party in default or uncollectible2015-09-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-09-30$607,157
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-09-30$606,208
Interest on participant loans2015-09-30$0
Interest earned on other investments2015-09-30$3,042
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-09-30$281,040
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-09-30$280,849
Expenses. Payments to insurance carriers foe the provision of benefits2015-09-30$0
Net investment gain/loss from pooled separate accounts2015-09-30$261
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-09-30No
Was there a failure to transmit to the plan any participant contributions2015-09-30No
Has the plan failed to provide any benefit when due under the plan2015-09-30No
Contributions received in cash from employer2015-09-30$57,776
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-09-30$121,632
Did the plan have assets held for investment2015-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-09-30Yes
Opinion of an independent qualified public accountant for this plan2015-09-30Disclaimer
Accountancy firm name2015-09-30GARY B. SAUNDERS, SAUNDERS & ASSOC.
Accountancy firm EIN2015-09-30208209116
2014 : 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$0
Total income from all sources (including contributions)2014-09-30$149,600
Total loss/gain on sale of assets2014-09-30$0
Total of all expenses incurred2014-09-30$94,659
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-09-30$94,659
Expenses. Certain deemed distributions of participant loans2014-09-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-09-30$101,266
Value of total assets at end of year2014-09-30$887,057
Value of total assets at beginning of year2014-09-30$832,116
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-09-30$0
Total interest from all sources2014-09-30$3,158
Total dividends received (eg from common stock, registered investment company shares)2014-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-09-30No
Was this plan covered by a fidelity bond2014-09-30Yes
Value of fidelity bond cover2014-09-30$90,000
If this is an individual account plan, was there a blackout period2014-09-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-09-30$0
Were there any nonexempt tranactions with any party-in-interest2014-09-30No
Contributions received from participants2014-09-30$51,429
Income. Received or receivable in cash from other sources (including rollovers)2014-09-30$0
Other income not declared elsewhere2014-09-30$0
Administrative expenses (other) incurred2014-09-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Value of net income/loss2014-09-30$54,941
Value of net assets at end of year (total assets less liabilities)2014-09-30$887,057
Value of net assets at beginning of year (total assets less liabilities)2014-09-30$832,116
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-09-30No
Were any leases to which the plan was party in default or uncollectible2014-09-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-09-30$606,208
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-09-30$523,197
Interest on participant loans2014-09-30$0
Interest earned on other investments2014-09-30$3,158
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-09-30$280,849
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-09-30$308,919
Expenses. Payments to insurance carriers foe the provision of benefits2014-09-30$0
Net investment gain/loss from pooled separate accounts2014-09-30$45,176
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-09-30No
Was there a failure to transmit to the plan any participant contributions2014-09-30Yes
Has the plan failed to provide any benefit when due under the plan2014-09-30No
Contributions received in cash from employer2014-09-30$49,837
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-09-30$94,659
Did the plan have assets held for investment2014-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-09-30Yes
Opinion of an independent qualified public accountant for this plan2014-09-30Disclaimer
Accountancy firm name2014-09-30RONALD C. COTTRELL, CPA
Accountancy firm EIN2014-09-30203712328
2013 : 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$0
Total income from all sources (including contributions)2013-09-30$173,695
Total loss/gain on sale of assets2013-09-30$0
Total of all expenses incurred2013-09-30$47,387
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-09-30$47,387
Expenses. Certain deemed distributions of participant loans2013-09-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-09-30$108,078
Value of total assets at end of year2013-09-30$832,116
Value of total assets at beginning of year2013-09-30$705,808
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-09-30$0
Total interest from all sources2013-09-30$3,748
Total dividends received (eg from common stock, registered investment company shares)2013-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-09-30No
Was this plan covered by a fidelity bond2013-09-30Yes
Value of fidelity bond cover2013-09-30$100,000
If this is an individual account plan, was there a blackout period2013-09-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-09-30$0
Were there any nonexempt tranactions with any party-in-interest2013-09-30No
Contributions received from participants2013-09-30$52,532
Income. Received or receivable in cash from other sources (including rollovers)2013-09-30$4,578
Other income not declared elsewhere2013-09-30$0
Administrative expenses (other) incurred2013-09-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Value of net income/loss2013-09-30$126,308
Value of net assets at end of year (total assets less liabilities)2013-09-30$832,116
Value of net assets at beginning of year (total assets less liabilities)2013-09-30$705,808
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-09-30No
Were any leases to which the plan was party in default or uncollectible2013-09-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-09-30$523,197
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-09-30$705,759
Interest on participant loans2013-09-30$0
Interest earned on other investments2013-09-30$3,748
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-09-30$308,919
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-09-30$49
Expenses. Payments to insurance carriers foe the provision of benefits2013-09-30$0
Net investment gain/loss from pooled separate accounts2013-09-30$61,869
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-09-30No
Was there a failure to transmit to the plan any participant contributions2013-09-30Yes
Has the plan failed to provide any benefit when due under the plan2013-09-30No
Contributions received in cash from employer2013-09-30$50,968
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-09-30$47,387
Did the plan have assets held for investment2013-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-09-30Yes
Opinion of an independent qualified public accountant for this plan2013-09-30Disclaimer
Accountancy firm name2013-09-30RONALD C. COTTRELL, CPA
Accountancy firm EIN2013-09-30203712328

Form 5500 Responses for 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL

2015: 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – InsuranceYes
2014: 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – InsuranceYes
2013: 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan benefit arrangement – InsuranceYes
2012: 403(B) THRIFT PLAN OF WASHITA VALLEY COMMUNITY ACTION COUNCIL 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number058793J
Policy instance 1
Insurance contract or identification number058793J
Number of Individuals Covered55
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $102
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 planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees102
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameDALLAS REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number058793J
Policy instance 1
Insurance contract or identification number058793J
Number of Individuals Covered55
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $303
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 planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees303
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameDALLAS REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number058793J
Policy instance 1
Insurance contract or identification number058793J
Number of Individuals Covered51
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,490
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 planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees2490
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameDALLAS REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number058793J
Policy instance 2
Insurance contract or identification number058793J
Number of Individuals Covered66
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-751234
Policy instance 1
Insurance contract or identification numberGA-751234
Number of Individuals Covered0
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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