401k Plan data: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. plan

TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 401k Plan overview

Plan Name	TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC.
Plan identification number	002

TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.

401k Sponsoring company profile

RISEBORO HOME CARE, INC. has sponsored the creation of one or more 401k plans.

Company Name: RISEBORO HOME CARE, INC.

Employer identification number (EIN): 112521680

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2020-01-01 D. ALEXANDRA DYER 2021-10-15
002 2019-01-01 ALEXANDRA DYER 2020-10-15
002 2018-01-01 SCOTT SHORT 2019-10-15
002 2017-01-01
002 2016-01-01
002 2015-01-01
002 2014-01-01 EXZERA HOPE GASKIN
002 2013-01-01 EXZERA HOPE GASKIN
002 2012-01-01 EXZERA HOPE GASKIN
002 2011-01-01 EXZERA HOPE GASKIN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2020-01-01	D. ALEXANDRA DYER	2021-10-15
002	2019-01-01	ALEXANDRA DYER	2020-10-15
002	2018-01-01	SCOTT SHORT	2019-10-15
002	2017-01-01
002	2016-01-01
002	2015-01-01
002	2014-01-01	EXZERA HOPE GASKIN
002	2013-01-01	EXZERA HOPE GASKIN
002	2012-01-01	EXZERA HOPE GASKIN
002	2011-01-01	EXZERA HOPE GASKIN

Plan Statistics for TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC.

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC.

Measure Date Value
2020: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2020 401k membership
Total participants, beginning-of-year 2020-01-01 978
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
Total of all active and inactive participants 2020-01-01 0
Total participants 2020-01-01 0
2019: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,096
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 973
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 5
Total of all active and inactive participants 2019-01-01 978
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 978
Number of participants with account balances 2019-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2018 401k membership
Total participants, beginning-of-year 2018-01-01 1,433
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1,092
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 4
Total of all active and inactive participants 2018-01-01 1,096
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 1,096
Number of participants with account balances 2018-01-01 12
2017: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1,947
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1,428
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 5
Total of all active and inactive participants 2017-01-01 1,433
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 1,433
Number of participants with account balances 2017-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1,746
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1,947
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 0
Total of all active and inactive participants 2016-01-01 1,947
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 1,947
Number of participants with account balances 2016-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,604
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,741
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 5
Total of all active and inactive participants 2015-01-01 1,746
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 1,746
Number of participants with account balances 2015-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2,788
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,600
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 4
Total of all active and inactive participants 2014-01-01 1,604
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 1,604
Number of participants with account balances 2014-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,625
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2,785
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 3
Total of all active and inactive participants 2013-01-01 2,788
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 2,788
Number of participants with account balances 2013-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2012 401k membership
Total participants, beginning-of-year 2012-01-01 3,802
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,621
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 4
Total of all active and inactive participants 2012-01-01 1,625
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 1,625
Number of participants with account balances 2012-01-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2,058
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 3,798
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 4
Total of all active and inactive participants 2011-01-01 3,802
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 3,802
Number of participants with account balances 2011-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2020: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2020 401k membership
Total participants, beginning-of-year	2020-01-01	978
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Total of all active and inactive participants	2020-01-01	0
Total participants	2020-01-01	0
2019: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,096
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	973
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	5
Total of all active and inactive participants	2019-01-01	978
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	978
Number of participants with account balances	2019-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2018 401k membership
Total participants, beginning-of-year	2018-01-01	1,433
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1,092
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	4
Total of all active and inactive participants	2018-01-01	1,096
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	1,096
Number of participants with account balances	2018-01-01	12
2017: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1,947
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1,428
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	5
Total of all active and inactive participants	2017-01-01	1,433
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	1,433
Number of participants with account balances	2017-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1,746
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1,947
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	0
Total of all active and inactive participants	2016-01-01	1,947
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	1,947
Number of participants with account balances	2016-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,604
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,741
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	5
Total of all active and inactive participants	2015-01-01	1,746
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	1,746
Number of participants with account balances	2015-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2,788
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,600
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	4
Total of all active and inactive participants	2014-01-01	1,604
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	1,604
Number of participants with account balances	2014-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,625
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2,785
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	3
Total of all active and inactive participants	2013-01-01	2,788
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	2,788
Number of participants with account balances	2013-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	3,802
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,621
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	4
Total of all active and inactive participants	2012-01-01	1,625
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	1,625
Number of participants with account balances	2012-01-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2,058
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3,798
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	4
Total of all active and inactive participants	2011-01-01	3,802
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	3,802
Number of participants with account balances	2011-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC.

Measure	Date	Value
2020 : TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2020-12-31	$962
Total unrealized appreciation/depreciation of assets	2020-12-31	$962
Total transfer of assets from this plan	2020-12-31	$281,344
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$962
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$7,769
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$7,761
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$0
Value of total assets at end of year	2020-12-31	$0
Value of total assets at beginning of year	2020-12-31	$288,151
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$8
Total interest from all sources	2020-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2020-12-31	$0
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$201
Administrative expenses (other) incurred	2020-12-31	$8
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$-6,807
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$288,151
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$18,110
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$269,840
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$7,761
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	PKF O'CONNOR DAVIES, LLP
Accountancy firm EIN	2020-12-31	271728945
2019 : TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
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 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 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	$15,978
Total income from all sources (including contributions)	2019-12-31	$15,978
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$10,248
Total of all expenses incurred	2019-12-31	$10,248
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$10,131
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$10,131
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$4,974
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$4,974
Value of total assets at end of year	2019-12-31	$288,151
Value of total assets at end of year	2019-12-31	$288,151
Value of total assets at beginning of year	2019-12-31	$282,421
Value of total assets at beginning of year	2019-12-31	$282,421
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$117
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$117
Total interest from all sources	2019-12-31	$8,096
Total interest from all sources	2019-12-31	$8,096
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
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
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
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$2,000,000
Value of fidelity bond cover	2019-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
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
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$4,974
Contributions received from participants	2019-12-31	$4,974
Participant contributions at end of year	2019-12-31	$201
Participant contributions at end of year	2019-12-31	$201
Participant contributions at beginning of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
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
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	$5,730
Value of net income/loss	2019-12-31	$5,730
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$288,151
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$288,151
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$282,421
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$282,421
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
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 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
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	$18,110
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$18,110
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$11,251
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$11,251
Interest earned on other investments	2019-12-31	$8,096
Interest earned on other investments	2019-12-31	$8,096
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$269,840
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$269,840
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$271,170
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$271,170
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$2,908
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$2,908
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
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
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
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$10,131
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$10,131
Contract administrator fees	2019-12-31	$117
Contract administrator fees	2019-12-31	$117
Did the plan have assets held for investment	2019-12-31	Yes
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
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
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
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
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	PKF O'CONNOR DAVIES, LLP
Accountancy firm name	2019-12-31	PKF O'CONNOR DAVIES, LLP
Accountancy firm EIN	2019-12-31	271728945
Accountancy firm EIN	2019-12-31	271728945
2018 : TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 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	$10,345
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$10,881
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$10,771
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$3,490
Value of total assets at end of year	2018-12-31	$282,421
Value of total assets at beginning of year	2018-12-31	$282,957
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$110
Total interest from all sources	2018-12-31	$8,116
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	$2,000,000
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	$3,490
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$45
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	$-536
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$282,421
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$282,957
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	$11,251
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$11,748
Interest earned on other investments	2018-12-31	$8,116
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$271,170
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$271,164
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-1,261
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$10,771
Contract administrator fees	2018-12-31	$110
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	PKF O'CONNOR DAVIES, LLP
Accountancy firm EIN	2018-12-31	271728945
2017 : TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 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	$20,655
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$317,216
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$317,102
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$2,450
Value of total assets at end of year	2017-12-31	$282,957
Value of total assets at beginning of year	2017-12-31	$579,518
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$114
Total interest from all sources	2017-12-31	$12,901
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	$2,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$2,450
Participant contributions at end of year	2017-12-31	$45
Participant contributions at beginning of year	2017-12-31	$205
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	$-296,561
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$282,957
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$579,518
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	$11,748
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$96,391
Interest earned on other investments	2017-12-31	$12,901
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$271,164
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$482,922
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$5,304
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	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$317,102
Contract administrator fees	2017-12-31	$114
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	PKF O'CONNOR DAVIES, LLP
Accountancy firm EIN	2017-12-31	271728945
2016 : TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 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	$29,358
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$19,035
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$18,916
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$10,545
Value of total assets at end of year	2016-12-31	$579,518
Value of total assets at beginning of year	2016-12-31	$569,195
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$119
Total interest from all sources	2016-12-31	$14,337
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	$2,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$10,545
Participant contributions at end of year	2016-12-31	$205
Participant contributions at beginning of year	2016-12-31	$500
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	$10,323
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$579,518
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$569,195
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	$96,391
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$83,726
Interest earned on other investments	2016-12-31	$14,337
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$482,922
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$484,969
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$4,476
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	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$18,916
Contract administrator fees	2016-12-31	$119
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	PKF O'CONNOR DAVIES, LLP
Accountancy firm EIN	2016-12-31	271728945
2015 : TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 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	$61,602
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$21,003
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$21,003
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$49,611
Value of total assets at end of year	2015-12-31	$569,195
Value of total assets at beginning of year	2015-12-31	$528,596
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$13,286
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	$2,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$13,850
Participant contributions at end of year	2015-12-31	$500
Participant contributions at beginning of year	2015-12-31	$750
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$35,761
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	$40,599
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$569,195
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$528,596
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	$83,726
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$85,873
Interest earned on other investments	2015-12-31	$13,286
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$484,969
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$441,973
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-1,295
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	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$21,003
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	PKF O'CONNOR DAVIES, LLP
Accountancy firm EIN	2015-12-31	271728945
2014 : TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, 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	$27,940
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$18,297
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$18,297
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$9,988
Value of total assets at end of year	2014-12-31	$528,596
Value of total assets at beginning of year	2014-12-31	$518,953
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$13,154
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	$2,000,000
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	$9,988
Participant contributions at end of year	2014-12-31	$750
Participant contributions at beginning of year	2014-12-31	$785
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	$9,643
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$528,596
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$518,953
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	$85,873
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$74,967
Interest earned on other investments	2014-12-31	$13,154
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$441,973
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$443,201
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$4,798
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$18,297
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	O'CONNOR DAVIES, LLP
Accountancy firm EIN	2014-12-31	271728945
2013 : TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 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	$58,541
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$46,109
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$46,109
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$36,629
Value of total assets at end of year	2013-12-31	$518,953
Value of total assets at beginning of year	2013-12-31	$506,521
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$0
Total interest from all sources	2013-12-31	$13,244
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	$2,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$12,882
Participant contributions at end of year	2013-12-31	$785
Participant contributions at beginning of year	2013-12-31	$850
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$23,747
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	$12,432
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$518,953
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$506,521
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	$74,967
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$56,739
Interest earned on other investments	2013-12-31	$13,244
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$443,201
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$448,932
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$8,668
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	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$46,109
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	O'CONNOR DAVIES, LLP
Accountancy firm EIN	2013-12-31	271728945
2012 : TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$38,168
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$38,832
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$38,832
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$20,079
Value of total assets at end of year	2012-12-31	$506,521
Value of total assets at beginning of year	2012-12-31	$507,185
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$0
Total interest from all sources	2012-12-31	$13,340
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$20,079
Participant contributions at end of year	2012-12-31	$850
Participant contributions at beginning of year	2012-12-31	$982
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-664
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$506,521
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$507,185
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$56,739
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$50,449
Interest earned on other investments	2012-12-31	$13,340
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$448,932
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$455,754
Net investment gain/loss from pooled separate accounts	2012-12-31	$4,749
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$38,832
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	O'CONNOR DAVIES, LLP
Accountancy firm EIN	2012-12-31	271728945
2011 : TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$36,639
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$28,434
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$28,434
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$25,140
Value of total assets at end of year	2011-12-31	$507,185
Value of total assets at beginning of year	2011-12-31	$498,980
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$0
Total interest from all sources	2011-12-31	$13,351
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$25,140
Participant contributions at end of year	2011-12-31	$982
Participant contributions at beginning of year	2011-12-31	$3,069
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$8,205
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$507,185
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$498,980
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$50,449
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$54,920
Interest earned on other investments	2011-12-31	$13,351
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$455,754
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$440,991
Net investment gain/loss from pooled separate accounts	2011-12-31	$-1,852
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$28,434
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	O'CONNOR DAVIES, LLP
Accountancy firm EIN	2011-12-31	271728945
2010 : TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$63,490
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$21,502
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$21,502
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$43,702
Value of total assets at end of year	2010-12-31	$498,980
Value of total assets at beginning of year	2010-12-31	$456,992
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$100,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$43,702
Participant contributions at end of year	2010-12-31	$3,069
Participant contributions at beginning of year	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$12,658
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$41,988
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$498,980
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$456,992
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$54,920
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$45,768
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$440,991
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$411,224
Net investment gain/loss from pooled separate accounts	2010-12-31	$7,130
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$21,502
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	O'CONNOR DAVIES MUNNS & DOBBINS LLP
Accountancy firm EIN	2010-12-31	133385019

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC.

2020: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	Yes
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: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 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: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, 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
2017: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 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 benefit arrangement – Insurance	Yes
2016: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 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 benefit arrangement – Insurance	Yes
2015: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, 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: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, 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 benefit arrangement – Insurance	Yes
2013: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 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 benefit arrangement – Insurance	Yes
2012: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: TAX DEFERRED ANNUITY PLAN OF RIDGEWOOD BUSHWICK SENIOR CITIZEN HOMECARE COUNCIL, INC. 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	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

008860-B

Policy instance

Insurance contract or identification number	008860-B
Number of Individuals Covered	0
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 $8
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	8
Additional information about fees paid to insurance broker	AGENT/BROKER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

008860-B

Policy instance

Insurance contract or identification number	008860-B
Number of Individuals Covered	13
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 $6
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	6
Additional information about fees paid to insurance broker	AGENT/BROKER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

008860-B

Policy instance

Insurance contract or identification number	008860-B
Number of Individuals Covered	12
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 $11
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	11
Additional information about fees paid to insurance broker	AGENT/BROKER COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

008860-8

Policy instance

Insurance contract or identification number	008860-8
Number of Individuals Covered	9
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 $49
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	49
Additional information about fees paid to insurance broker	AGENT/BROKER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MUTUAL OF AMERICA

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

Policy contract number

008860-8

Policy instance

Insurance contract or identification number	008860-8
Number of Individuals Covered	13
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 $10
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	10
Additional information about fees paid to insurance broker	AGENT/BROKER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MUTUAL OF AMERICA

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

Policy contract number

008860-8

Policy instance

Insurance contract or identification number	008860-8
Number of Individuals Covered	15
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 $20
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	20
Additional information about fees paid to insurance broker	AGENT/BROKER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MUTUAL OF AMERICA

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

Policy contract number

008860-8

Policy instance

Insurance contract or identification number	008860-8
Number of Individuals Covered	18
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 $23
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	23
Additional information about fees paid to insurance broker	AGENT/BROKER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MUTUAL OF AMERICA

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

Policy contract number

008860-8

Policy instance

Insurance contract or identification number	008860-8
Number of Individuals Covered	25
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $33
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	11
Additional information about fees paid to insurance broker	INSURANCE AGENT OR BROKER
Insurance broker organization code?	3
Insurance broker name	ABE GARCIA

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

Policy contract number

008860-8

Policy instance

Insurance contract or identification number	008860-8
Number of Individuals Covered	29
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $133
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

008860-8

Policy instance

Insurance contract or identification number	008860-8
Number of Individuals Covered	28
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $105
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	0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	RISEBORO HOME CARE, INC.
Employer identification number (EIN):	112521680
NAIC Classification:	621610
NAIC Description:	Home Health Care Services