401k Plan data: EMPLOYEE BENEFIT PLAN OF FLORA, INC. plan

EMPLOYEE BENEFIT PLAN OF FLORA, INC. 401k Plan overview

Plan Name	EMPLOYEE BENEFIT PLAN OF FLORA, INC.
Plan identification number	001

EMPLOYEE BENEFIT PLAN OF FLORA, INC. Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

FLORA, INC. has sponsored the creation of one or more 401k plans.

Company Name: FLORA, INC.

Employer identification number (EIN): 911747264

NAIC Classification: 339900

Additional information about FLORA, INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1994-12-16

Company Identification Number: 601592376

Legal Registered Office Address: 230 E CHAMPION ST

BELLINGHAM
United States of America (USA)
982254548

More information about FLORA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT PLAN OF FLORA, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 MARGARET WONG 2023-06-27
001 2021-01-01 MARGARET WONG 2022-06-02
001 2020-01-01
001 2020-01-01
001 2019-01-01
001 2019-01-01
001 2018-01-01 MARGARET WONG
001 2017-01-01 MARGARET WONG 2018-07-10
001 2016-01-01 MARGARET WONG 2017-07-11
001 2015-01-01 MARGARET WONG
001 2014-01-01 MARGARET WONG

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	MARGARET WONG	2023-06-27
001	2021-01-01	MARGARET WONG	2022-06-02
001	2020-01-01
001	2020-01-01
001	2019-01-01
001	2019-01-01
001	2018-01-01	MARGARET WONG
001	2017-01-01	MARGARET WONG	2018-07-10
001	2016-01-01	MARGARET WONG	2017-07-11
001	2015-01-01	MARGARET WONG
001	2014-01-01	MARGARET WONG

Plan Statistics for EMPLOYEE BENEFIT PLAN OF FLORA, INC.

401k plan membership statisitcs for EMPLOYEE BENEFIT PLAN OF FLORA, INC.

Measure Date Value
2020: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2020 401k membership
Total participants, beginning-of-year 2020-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 55
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 39
Total of all active and inactive participants 2020-01-01 94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 94
Number of participants with account balances 2020-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2019 401k membership
Total participants, beginning-of-year 2019-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 70
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 35
Total of all active and inactive participants 2019-01-01 105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 105
Number of participants with account balances 2019-01-01 105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2018 401k membership
Total participants, beginning-of-year 2018-01-01 100
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 28
Total of all active and inactive participants 2018-01-01 106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 106
Number of participants with account balances 2018-01-01 104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2015: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 67
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 26
Total of all active and inactive participants 2015-01-01 93
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 93
Number of participants with account balances 2015-01-01 93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 16
2014: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 64
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 37
Total of all active and inactive participants 2014-01-01 101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 101
Number of participants with account balances 2014-01-01 101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2020: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2020 401k membership
Total participants, beginning-of-year	2020-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	55
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	39
Total of all active and inactive participants	2020-01-01	94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	94
Number of participants with account balances	2020-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2019 401k membership
Total participants, beginning-of-year	2019-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	70
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	35
Total of all active and inactive participants	2019-01-01	105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	105
Number of participants with account balances	2019-01-01	105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2018 401k membership
Total participants, beginning-of-year	2018-01-01	100
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	28
Total of all active and inactive participants	2018-01-01	106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	106
Number of participants with account balances	2018-01-01	104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2015: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	67
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	26
Total of all active and inactive participants	2015-01-01	93
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	93
Number of participants with account balances	2015-01-01	93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	16
2014: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	64
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	37
Total of all active and inactive participants	2014-01-01	101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	101
Number of participants with account balances	2014-01-01	101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on EMPLOYEE BENEFIT PLAN OF FLORA, INC.

Measure	Date	Value
2020 : EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2020 401k financial data
Transfers to/from the plan	2020-12-31	$0
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$898,243
Expenses. Total of all expenses incurred	2020-12-31	$284,188
Benefits paid (including direct rollovers)	2020-12-31	$269,900
Total plan assets at end of year	2020-12-31	$4,947,931
Total plan assets at beginning of year	2020-12-31	$4,333,876
Value of fidelity bond covering the plan	2020-12-31	$500,000
Total contributions received or receivable from participants	2020-12-31	$130,260
Expenses. Other expenses not covered elsewhere	2020-12-31	$14,288
Contributions received from other sources (not participants or employers)	2020-12-31	$4,736
Other income received	2020-12-31	$646,010
Net income (gross income less expenses)	2020-12-31	$614,055
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$4,947,931
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$4,333,876
Total contributions received or receivable from employer(s)	2020-12-31	$117,237
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$1,097,034
Expenses. Total of all expenses incurred	2019-12-31	$204,266
Benefits paid (including direct rollovers)	2019-12-31	$194,282
Total plan assets at end of year	2019-12-31	$4,333,876
Total plan assets at beginning of year	2019-12-31	$3,441,108
Value of fidelity bond covering the plan	2019-12-31	$500,000
Total contributions received or receivable from participants	2019-12-31	$154,793
Expenses. Other expenses not covered elsewhere	2019-12-31	$9,984
Contributions received from other sources (not participants or employers)	2019-12-31	$121,714
Other income received	2019-12-31	$686,639
Net income (gross income less expenses)	2019-12-31	$892,768
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$4,333,876
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$3,441,108
Total contributions received or receivable from employer(s)	2019-12-31	$133,888
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2018 401k financial data
Transfers to/from the plan	2018-12-31	$0
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$0
Total income from all sources	2018-12-31	$26,361
Expenses. Total of all expenses incurred	2018-12-31	$75,069
Benefits paid (including direct rollovers)	2018-12-31	$73,787
Total plan assets at end of year	2018-12-31	$3,441,108
Total plan assets at beginning of year	2018-12-31	$3,489,816
Value of fidelity bond covering the plan	2018-12-31	$500,000
Total contributions received or receivable from participants	2018-12-31	$127,377
Expenses. Other expenses not covered elsewhere	2018-12-31	$1,282
Contributions received from other sources (not participants or employers)	2018-12-31	$15,367
Other income received	2018-12-31	$-240,106
Net income (gross income less expenses)	2018-12-31	$-48,708
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$3,441,108
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$3,489,816
Total contributions received or receivable from employer(s)	2018-12-31	$123,723
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2015 : EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$222,236
Expenses. Total of all expenses incurred	2015-12-31	$89,525
Benefits paid (including direct rollovers)	2015-12-31	$87,960
Total plan assets at end of year	2015-12-31	$2,694,160
Total plan assets at beginning of year	2015-12-31	$2,561,449
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$107,245
Expenses. Other expenses not covered elsewhere	2015-12-31	$1,565
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$14,948
Net income (gross income less expenses)	2015-12-31	$132,711
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$2,694,160
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$2,561,449
Total contributions received or receivable from employer(s)	2015-12-31	$100,043
Value of certain deemed distributions of participant loans	2015-12-31	$0
2014 : EMPLOYEE BENEFIT PLAN OF FLORA, INC. 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	$350,399
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$237,392
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$235,667
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	$216,692
Value of total assets at end of year	2014-12-31	$2,561,449
Value of total assets at beginning of year	2014-12-31	$2,448,442
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$1,725
Total interest from all sources	2014-12-31	$7,943
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	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$108,325
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$0
Other income not declared elsewhere	2014-12-31	$1
Administrative expenses (other) incurred	2014-12-31	$1,725
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	$113,007
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,561,449
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,448,442
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	$1,683,263
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$1,538,136
Interest on participant loans	2014-12-31	$0
Interest earned on other investments	2014-12-31	$7,943
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$878,186
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$910,306
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	$125,763
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	$108,367
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$235,667
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	MOSS ADAMS
Accountancy firm EIN	2014-12-31	910189318

Form 5500 Responses for EMPLOYEE BENEFIT PLAN OF FLORA, INC.

2020: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	Yes
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	Yes
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 BENEFIT PLAN OF FLORA, INC. 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
2015: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: EMPLOYEE BENEFIT PLAN OF FLORA, INC. 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

Insurance Providers Used on plan

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

Policy contract number

055276H

Policy instance

Insurance contract or identification number	055276H
Number of Individuals Covered	94
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $752
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	752
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

055276H

Policy instance

Insurance contract or identification number	055276H
Number of Individuals Covered	105
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 $909
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	909
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

055276H

Policy instance

Insurance contract or identification number	055276H
Number of Individuals Covered	106
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 $899
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	899
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

055276H

Policy instance

Insurance contract or identification number	055276H
Number of Individuals Covered	93
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 $326
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	326
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	SEATTLE REGIONAL OFFICE

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

Policy contract number

055276H

Policy instance

Insurance contract or identification number	055276H
Number of Individuals Covered	101
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 $966
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	966
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	SEATTLE REGIONAL OFFICE

Potentially related plans

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Company Name:	FLORA, INC.
Employer identification number (EIN):	911747264
NAIC Classification:	339900

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1994-12-16
Company Identification Number:	601592376
Legal Registered Office Address:	230 E CHAMPION ST BELLINGHAM United States of America (USA) 982254548