401k Plan data: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY plan

EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 401k Plan overview

Plan Name	EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY
Plan identification number	002

EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Money purchase (other than target benefit)
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.
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

BOYS & GIRLS CLUBS OF THE VALLEY, INC. has sponsored the creation of one or more 401k plans.

Company Name: BOYS & GIRLS CLUBS OF THE VALLEY, INC.

Employer identification number (EIN): 860550646

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2020-01-01 SWATI WEBB 2021-03-15
002 2019-01-01
002 2018-01-01 JOAN HIBDON
002 2017-01-01 DIANE SHERWOOD DIANE SHERWOOD 2018-07-27
002 2016-01-01 DIANE SHERWOOD DIANE SHERWOOD 2017-07-13
002 2015-01-01 DIANE SHERWOOD DIANE SHERWOOD 2016-08-01
002 2014-01-01 DIANE SHERWOOD DIANE SHERWOOD 2015-08-26
002 2013-01-01 SWATI WEBB
002 2012-01-01 SWATI WEBB 2013-07-23
002 2011-01-01 SWATI WEBB 2012-06-25
002 2010-01-01 SWATI WEBB 2011-07-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2020-01-01	SWATI WEBB	2021-03-15
002	2019-01-01
002	2018-01-01	JOAN HIBDON
002	2017-01-01	DIANE SHERWOOD		DIANE SHERWOOD	2018-07-27
002	2016-01-01	DIANE SHERWOOD		DIANE SHERWOOD	2017-07-13
002	2015-01-01	DIANE SHERWOOD		DIANE SHERWOOD	2016-08-01
002	2014-01-01	DIANE SHERWOOD		DIANE SHERWOOD	2015-08-26
002	2013-01-01	SWATI WEBB
002	2012-01-01	SWATI WEBB	2013-07-23
002	2011-01-01	SWATI WEBB	2012-06-25
002	2010-01-01	SWATI WEBB	2011-07-14

Plan Statistics for EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY

401k plan membership statisitcs for EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY

Measure Date Value
2019: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2019 401k membership
Total participants, beginning-of-year 2019-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 76
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 38
Total of all active and inactive participants 2019-01-01 114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 1
Total participants 2019-01-01 115
Number of participants with account balances 2019-01-01 114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2018 401k membership
Total participants, beginning-of-year 2018-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 78
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 39
Total of all active and inactive participants 2018-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 1
Total participants 2018-01-01 118
Number of participants with account balances 2018-01-01 97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 7
2017: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2017 401k membership
Total participants, beginning-of-year 2017-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 80
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 33
Total of all active and inactive participants 2017-01-01 113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 113
Number of participants with account balances 2017-01-01 96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 21
2016: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2016 401k membership
Total participants, beginning-of-year 2016-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 80
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 36
Total of all active and inactive participants 2016-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 1
Total participants 2016-01-01 117
Number of participants with account balances 2016-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 14
2015: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2015 401k membership
Total participants, beginning-of-year 2015-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 84
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 32
Total of all active and inactive participants 2015-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 1
Total participants 2015-01-01 117
Number of participants with account balances 2015-01-01 117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 15
2014: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2014 401k membership
Total participants, beginning-of-year 2014-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 91
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 20
Total of all active and inactive participants 2014-01-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 111
Number of participants with account balances 2014-01-01 111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 13
2013: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2013 401k membership
Total participants, beginning-of-year 2013-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 87
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 44
Total of all active and inactive participants 2013-01-01 131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 132
Number of participants with account balances 2013-01-01 132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 12

Measure	Date	Value
2019: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2019 401k membership
Total participants, beginning-of-year	2019-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	76
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	38
Total of all active and inactive participants	2019-01-01	114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	115
Number of participants with account balances	2019-01-01	114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2018 401k membership
Total participants, beginning-of-year	2018-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	78
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	39
Total of all active and inactive participants	2018-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	118
Number of participants with account balances	2018-01-01	97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	7
2017: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2017 401k membership
Total participants, beginning-of-year	2017-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	80
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	33
Total of all active and inactive participants	2017-01-01	113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	113
Number of participants with account balances	2017-01-01	96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	21
2016: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2016 401k membership
Total participants, beginning-of-year	2016-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	80
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	36
Total of all active and inactive participants	2016-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	1
Total participants	2016-01-01	117
Number of participants with account balances	2016-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	14
2015: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2015 401k membership
Total participants, beginning-of-year	2015-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	84
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	32
Total of all active and inactive participants	2015-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	1
Total participants	2015-01-01	117
Number of participants with account balances	2015-01-01	117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	15
2014: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2014 401k membership
Total participants, beginning-of-year	2014-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	91
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	20
Total of all active and inactive participants	2014-01-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	111
Number of participants with account balances	2014-01-01	111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	13
2013: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2013 401k membership
Total participants, beginning-of-year	2013-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	87
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	44
Total of all active and inactive participants	2013-01-01	131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	132
Number of participants with account balances	2013-01-01	132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	12

Financial Data on EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY

Measure	Date	Value
2019 : EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$704,694
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$382,802
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$381,312
Expenses. Certain deemed distributions of participant loans	2019-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$137,542
Value of total assets at end of year	2019-12-31	$2,975,733
Value of total assets at beginning of year	2019-12-31	$2,653,841
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,490
Total interest from all sources	2019-12-31	$5,041
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$250,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$10,611
Participant contributions at end of year	2019-12-31	$67,634
Participant contributions at beginning of year	2019-12-31	$20,333
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$0
Other income not declared elsewhere	2019-12-31	$0
Administrative expenses (other) incurred	2019-12-31	$1,490
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$321,892
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,975,733
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,653,841
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,815,593
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,540,270
Interest on participant loans	2019-12-31	$3,397
Interest earned on other investments	2019-12-31	$1,644
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$92,506
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$93,238
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$0
Net investment gain/loss from pooled separate accounts	2019-12-31	$562,111
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$126,931
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$381,312
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	KIMBERLIN COMPANY, PLLC
Accountancy firm EIN	2019-12-31	455497718
2018 : EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$-94,899
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$181,308
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$179,851
Expenses. Certain deemed distributions of participant loans	2018-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$131,095
Value of total assets at end of year	2018-12-31	$2,653,841
Value of total assets at beginning of year	2018-12-31	$2,930,048
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$1,457
Total interest from all sources	2018-12-31	$2,202
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$250,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$9,814
Participant contributions at end of year	2018-12-31	$20,333
Participant contributions at beginning of year	2018-12-31	$24,831
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$0
Other income not declared elsewhere	2018-12-31	$0
Administrative expenses (other) incurred	2018-12-31	$1,457
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-276,207
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$2,653,841
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,930,048
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$2,540,270
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$2,798,509
Interest on participant loans	2018-12-31	$1,191
Interest earned on other investments	2018-12-31	$1,011
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$93,238
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$106,708
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$0
Net investment gain/loss from pooled separate accounts	2018-12-31	$-228,196
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$121,281
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$179,851
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	KIMBERLIN COMPANY, PLLC
Accountancy firm EIN	2018-12-31	455497718
2017 : EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$583,970
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$138,433
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$136,919
Expenses. Certain deemed distributions of participant loans	2017-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$169,105
Value of total assets at end of year	2017-12-31	$2,930,048
Value of total assets at beginning of year	2017-12-31	$2,484,511
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$1,514
Total interest from all sources	2017-12-31	$1,157
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$250,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$4,460
Participant contributions at end of year	2017-12-31	$24,831
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$45,659
Administrative expenses (other) incurred	2017-12-31	$1,514
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$445,537
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,930,048
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,484,511
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$2,798,509
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$2,372,582
Interest on participant loans	2017-12-31	$50
Interest earned on other investments	2017-12-31	$1,107
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$106,708
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$111,929
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$0
Net investment gain/loss from pooled separate accounts	2017-12-31	$413,708
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$118,986
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$136,919
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	KIMBERLIN COMPANY, PLLC
Accountancy firm EIN	2017-12-31	455497718
2016 : EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$278,982
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$559,718
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$558,134
Expenses. Certain deemed distributions of participant loans	2016-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$111,316
Value of total assets at end of year	2016-12-31	$2,484,511
Value of total assets at beginning of year	2016-12-31	$2,765,247
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,584
Total interest from all sources	2016-12-31	$1,295
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$250,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$0
Other income not declared elsewhere	2016-12-31	$0
Administrative expenses (other) incurred	2016-12-31	$1,584
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-280,736
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,484,511
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,765,247
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$2,372,582
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$2,608,225
Interest on participant loans	2016-12-31	$0
Interest earned on other investments	2016-12-31	$1,295
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$111,929
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$157,022
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$0
Net investment gain/loss from pooled separate accounts	2016-12-31	$166,371
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$111,316
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$558,134
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	RUSS KIMBERLIN, CPA LLC
Accountancy firm EIN	2016-12-31	455497718
2015 : EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$102,353
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$446,066
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$443,837
Expenses. Certain deemed distributions of participant loans	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$134,298
Value of total assets at end of year	2015-12-31	$2,765,247
Value of total assets at beginning of year	2015-12-31	$3,108,960
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$2,229
Total interest from all sources	2015-12-31	$1,187
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$250,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$0
Other income not declared elsewhere	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$2,229
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-343,713
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,765,247
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$3,108,960
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$2,608,225
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$3,006,481
Interest on participant loans	2015-12-31	$0
Interest earned on other investments	2015-12-31	$1,187
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$157,022
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$102,479
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$0
Net investment gain/loss from pooled separate accounts	2015-12-31	$-33,132
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$134,298
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$443,837
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	RUSS KIMBERLIN, CPA LLC
Accountancy firm EIN	2015-12-31	455497718
2014 : EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$299,756
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$179,206
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$177,093
Expenses. Certain deemed distributions of participant loans	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$134,243
Value of total assets at end of year	2014-12-31	$3,108,960
Value of total assets at beginning of year	2014-12-31	$2,988,410
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$2,113
Total interest from all sources	2014-12-31	$1,140
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
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	$250,000
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
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	$134,243
Amount contributed by the employer to the plan for this plan year	2014-12-31	$134,243
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$2
Administrative expenses (other) incurred	2014-12-31	$2,113
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	$120,550
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$3,108,960
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,988,410
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 registered invesment companies (eg mutual funds) at end of year	2014-12-31	$3,006,481
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$2,868,732
Interest on participant loans	2014-12-31	$0
Interest earned on other investments	2014-12-31	$1,140
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$102,479
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$119,678
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$0
Net investment gain/loss from pooled separate accounts	2014-12-31	$164,371
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	No
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	$134,243
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$177,093
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	RUSS KIMBERLIN, CPA PLLC
Accountancy firm EIN	2014-12-31	455497718
2013 : EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$653,527
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$85,050
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$77,463
Expenses. Certain deemed distributions of participant loans	2013-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$131,006
Value of total assets at end of year	2013-12-31	$2,988,410
Value of total assets at beginning of year	2013-12-31	$2,419,933
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$7,587
Total interest from all sources	2013-12-31	$1,451
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
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	$250,000
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
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	$131,006
Amount contributed by the employer to the plan for this plan year	2013-12-31	$131,006
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$0
Other income not declared elsewhere	2013-12-31	$0
Administrative expenses (other) incurred	2013-12-31	$7,587
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	$568,477
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,988,410
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,419,933
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 registered invesment companies (eg mutual funds) at end of year	2013-12-31	$2,868,732
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$2,272,254
Interest on participant loans	2013-12-31	$0
Interest earned on other investments	2013-12-31	$1,451
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$119,678
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$147,679
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$0
Net investment gain/loss from pooled separate accounts	2013-12-31	$521,070
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	$131,006
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$77,463
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	RUSS KIMBERLIN, CPA PLLC
Accountancy firm EIN	2013-12-31	455497718

Form 5500 Responses for EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY

2019: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 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
2014: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: EMPLOYEE BENEFITS PLAN OF BOYS & GIRLS CLUB OF THE OF THE EAST VALLEY 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	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

056707C

Policy instance

Insurance contract or identification number	056707C
Number of Individuals Covered	115
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $120
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	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
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	120
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

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

Policy contract number

056707C

Policy instance

Insurance contract or identification number	056707C
Number of Individuals Covered	118
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $799
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	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
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	799
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

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

Policy contract number

056707C

Policy instance

Insurance contract or identification number	056707C
Number of Individuals Covered	113
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $647
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	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
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	647
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	PHOENIX REGIONAL OFFICE

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

Policy contract number

056707C

Policy instance

Insurance contract or identification number	056707C
Number of Individuals Covered	117
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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

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

Policy contract number

056707C

Policy instance

Insurance contract or identification number	056707C
Number of Individuals Covered	111
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $157
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
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	157
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	PHOENIX REGIONAL OFFICE

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

Policy contract number

056707C

Policy instance

Insurance contract or identification number	056707C
Number of Individuals Covered	132
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $618
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
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	618
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	PHOENIX REGIONAL OFFICE

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Company Name:	BOYS & GIRLS CLUBS OF THE VALLEY, INC.
Employer identification number (EIN):	860550646
NAIC Classification:	624100
NAIC Description:	Individual and Family Services