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TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 401k Plan overview

Plan NameTAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC.
Plan identification number 002

TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • 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.

401k Sponsoring company profile

A VERY SPECIAL PLACE,INC. has sponsored the creation of one or more 401k plans.

Company Name:A VERY SPECIAL PLACE,INC.
Employer identification number (EIN):133005006
NAIC Classification:624100
NAIC Description: Individual and Family Services

Additional information about A VERY SPECIAL PLACE,INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1974-11-26
Company Identification Number: 356796
Legal Registered Office Address: 49 CEDAR GROVE AVENUE
Richmond
STATEN ISLAND
United States of America (USA)
10306

More information about A VERY SPECIAL PLACE,INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01ANN MARIE HARTNETT2023-10-16 ANN MARIE HARTNETT2023-10-16
0022021-01-01ANN MARIE HARTNETT2022-10-06 ANN MARIE HARTNETT2022-10-06
0022020-01-01ANN MARIE HARTNETT2022-01-03 ANN MARIE HARTNETT2022-01-03
0022019-01-01ANN MARIE HARTNETT2020-10-15 ANN MARIE HARTNETT2020-10-15
0022018-01-01ANN MARIE HARTNETT2019-10-15 ANN MARIE HARTNETT2019-10-15
0022017-01-01ANN MARIE HARTNETT ANN MARIE HARTNETT2018-10-12
0022017-01-01ANN MARIE HARTNETT ANN MARIE HARTNETT2018-10-12
0022016-01-01ANN MARIE HARTNETT ANN MARIE HARTNETT2017-10-13
0022015-01-01ANN MARIE HARTNETT ANN MARIE HARTNETT2016-10-17
0022014-01-01ANN MARIE HARTNETT ANN MARIE HARTNETT2015-10-26
0022014-01-01ANN MARIE HARTNETT ANN MARIE HARTNETT2015-10-26
0022013-01-01ANN MARIE HARTNETT
0022012-01-01ANN MARIE HARTNETT ANN MARIE HARTNETT2013-10-15
0022011-01-01ANN MARIE HARTNETT ANN MARIE HARTNETT2012-10-15
0022009-01-01ANN MARIE HARNETT ANN MARIE HARTNETT2010-10-19
0022009-01-01ANN MARIE HARTNETT

Plan Statistics for TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC.

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC.

Measure Date Value
2017: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2017 401k membership
Total participants, beginning-of-year2017-01-0187
Total number of active participants reported on line 7a of the Form 55002017-01-0147
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0144
Total of all active and inactive participants2017-01-0191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0191
Number of participants with account balances2017-01-0188
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2016 401k membership
Total participants, beginning-of-year2016-01-0194
Total number of active participants reported on line 7a of the Form 55002016-01-0138
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0149
Total of all active and inactive participants2016-01-0187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0187
Number of participants with account balances2016-01-0184
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2015 401k membership
Total participants, beginning-of-year2015-01-0198
Total number of active participants reported on line 7a of the Form 55002015-01-0147
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0147
Total of all active and inactive participants2015-01-0194
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0194
Number of participants with account balances2015-01-0194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2014 401k membership
Total participants, beginning-of-year2014-01-0197
Total number of active participants reported on line 7a of the Form 55002014-01-0151
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0147
Total of all active and inactive participants2014-01-0198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0198
Number of participants with account balances2014-01-0198
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2013 401k membership
Total participants, beginning-of-year2013-01-01104
Total number of active participants reported on line 7a of the Form 55002013-01-0152
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0145
Total of all active and inactive participants2013-01-0197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0197
Number of participants with account balances2013-01-0197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2012 401k membership
Total participants, beginning-of-year2012-01-01101
Total number of active participants reported on line 7a of the Form 55002012-01-0158
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0145
Total of all active and inactive participants2012-01-01103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-011
Total participants2012-01-01104
Number of participants with account balances2012-01-01104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2011 401k membership
Total participants, beginning-of-year2011-01-0196
Total number of active participants reported on line 7a of the Form 55002011-01-0159
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0141
Total of all active and inactive participants2011-01-01100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-011
Total participants2011-01-01101
Number of participants with account balances2011-01-01101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2009 401k membership
Total participants, beginning-of-year2009-01-0152
Total number of active participants reported on line 7a of the Form 55002009-01-0152
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0146
Total of all active and inactive participants2009-01-0198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-011
Total participants2009-01-0199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC.

Measure Date Value
2017 : TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2017 401k financial data
Transfers to/from the plan2017-12-31$0
Total plan liabilities at end of year2017-12-31$0
Total plan liabilities at beginning of year2017-12-31$0
Total income from all sources2017-12-31$577,049
Expenses. Total of all expenses incurred2017-12-31$120,171
Benefits paid (including direct rollovers)2017-12-31$114,014
Total plan assets at end of year2017-12-31$4,089,958
Total plan assets at beginning of year2017-12-31$3,633,080
Total contributions received or receivable from participants2017-12-31$155,090
Expenses. Other expenses not covered elsewhere2017-12-31$939
Contributions received from other sources (not participants or employers)2017-12-31$0
Other income received2017-12-31$421,959
Net income (gross income less expenses)2017-12-31$456,878
Net plan assets at end of year (total assets less liabilities)2017-12-31$4,089,958
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$3,633,080
Assets. Value of participant loans2017-12-31$7,448
Total contributions received or receivable from employer(s)2017-12-31$0
Value of certain deemed distributions of participant loans2017-12-31$5,218
2016 : TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2016 401k financial data
Transfers to/from the plan2016-12-31$0
Total plan liabilities at end of year2016-12-31$0
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$467,317
Expenses. Total of all expenses incurred2016-12-31$75,395
Benefits paid (including direct rollovers)2016-12-31$67,267
Total plan assets at end of year2016-12-31$3,633,080
Total plan assets at beginning of year2016-12-31$3,241,158
Total contributions received or receivable from participants2016-12-31$152,883
Expenses. Other expenses not covered elsewhere2016-12-31$8,128
Contributions received from other sources (not participants or employers)2016-12-31$53,995
Other income received2016-12-31$260,439
Net income (gross income less expenses)2016-12-31$391,922
Net plan assets at end of year (total assets less liabilities)2016-12-31$3,633,080
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$3,241,158
Assets. Value of participant loans2016-12-31$11,961
Total contributions received or receivable from employer(s)2016-12-31$0
Value of certain deemed distributions of participant loans2016-12-31$0
2015 : TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2015 401k financial data
Transfers to/from the plan2015-12-31$0
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$265,828
Expenses. Total of all expenses incurred2015-12-31$188,815
Benefits paid (including direct rollovers)2015-12-31$188,194
Total plan assets at end of year2015-12-31$3,241,158
Total plan assets at beginning of year2015-12-31$3,164,145
Total contributions received or receivable from participants2015-12-31$181,897
Expenses. Other expenses not covered elsewhere2015-12-31$621
Contributions received from other sources (not participants or employers)2015-12-31$72,951
Other income received2015-12-31$10,980
Net income (gross income less expenses)2015-12-31$77,013
Net plan assets at end of year (total assets less liabilities)2015-12-31$3,241,158
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$3,164,145
Assets. Value of participant loans2015-12-31$22,438
Total contributions received or receivable from employer(s)2015-12-31$0
Value of certain deemed distributions of participant loans2015-12-31$0
2014 : TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$352,240
Expenses. Total of all expenses incurred2014-12-31$21,137
Benefits paid (including direct rollovers)2014-12-31$21,137
Total plan assets at end of year2014-12-31$3,164,145
Total plan assets at beginning of year2014-12-31$2,833,042
Total contributions received or receivable from participants2014-12-31$173,644
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$11,673
Other income received2014-12-31$166,923
Net income (gross income less expenses)2014-12-31$331,103
Net plan assets at end of year (total assets less liabilities)2014-12-31$3,164,145
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$2,833,042
Assets. Value of participant loans2014-12-31$28,784
Total contributions received or receivable from employer(s)2014-12-31$0
Value of certain deemed distributions of participant loans2014-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2013 401k financial data
Total income from all sources2013-12-31$523,750
Expenses. Total of all expenses incurred2013-12-31$36,796
Benefits paid (including direct rollovers)2013-12-31$36,792
Total plan assets at end of year2013-12-31$2,833,042
Total plan assets at beginning of year2013-12-31$2,346,088
Total contributions received or receivable from participants2013-12-31$201,002
Expenses. Other expenses not covered elsewhere2013-12-31$4
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$322,748
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$486,954
Net plan assets at end of year (total assets less liabilities)2013-12-31$2,833,042
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$2,346,088
Assets. Value of participant loans2013-12-31$24,130
Total contributions received or receivable from employer(s)2013-12-31$0
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2012 401k financial data
Total income from all sources2012-12-31$193,587
Expenses. Total of all expenses incurred2012-12-31$0
Total plan assets at end of year2012-12-31$2,346,088
Total plan assets at beginning of year2012-12-31$2,029,916
Total contributions received or receivable from participants2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$0
Net income (gross income less expenses)2012-12-31$193,587
Net plan assets at end of year (total assets less liabilities)2012-12-31$2,346,088
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$2,029,916
Assets. Value of participant loans2012-12-31$33,688
Total contributions received or receivable from employer(s)2012-12-31$193,587
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$191,900
Expenses. Total of all expenses incurred2011-12-31$19,451
Benefits paid (including direct rollovers)2011-12-31$18,205
Total plan assets at end of year2011-12-31$2,029,916
Total plan assets at beginning of year2011-12-31$1,857,467
Total contributions received or receivable from participants2011-12-31$175,171
Expenses. Other expenses not covered elsewhere2011-12-31$1,246
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$16,729
Net income (gross income less expenses)2011-12-31$172,449
Net plan assets at end of year (total assets less liabilities)2011-12-31$2,029,916
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,857,467
Assets. Value of participant loans2011-12-31$32,937
Total contributions received or receivable from employer(s)2011-12-31$0
Value of certain deemed distributions of participant loans2011-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$318,859
Expenses. Total of all expenses incurred2010-12-31$66,249
Benefits paid (including direct rollovers)2010-12-31$53,723
Total plan assets at end of year2010-12-31$1,846,266
Total plan assets at beginning of year2010-12-31$1,593,656
Total contributions received or receivable from participants2010-12-31$164,430
Expenses. Other expenses not covered elsewhere2010-12-31$1,325
Contributions received from other sources (not participants or employers)2010-12-31$3,672
Other income received2010-12-31$150,757
Net income (gross income less expenses)2010-12-31$252,610
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,846,266
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,593,656
Assets. Value of participant loans2010-12-31$13,256
Total contributions received or receivable from employer(s)2010-12-31$0
Value of certain deemed distributions of participant loans2010-12-31$11,201
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC.

2017: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: TAX DEFERRED ANNUITY PLAN OF A VERY SPECIAL PLACE,INC. 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number052671J
Policy instance 1
Insurance contract or identification number052671J
Number of Individuals Covered91
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $906
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 planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees906
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP PROGRAM
Insurance broker organization code?3
Insurance broker nameQUEENS REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number052671J
Policy instance 1
Insurance contract or identification number052671J
Number of Individuals Covered94
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $174
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees174
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameQUEENS REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number052671J
Policy instance 1
Insurance contract or identification number052671J
Number of Individuals Covered98
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $305
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees305
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameQUEENS REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number052671J
Policy instance 1
Insurance contract or identification number052671J
Number of Individuals Covered97
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $211
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees211
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameQUEENS REGIONAL OFFICE
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number052671J
Policy instance 1
Insurance contract or identification number052671J
Number of Individuals Covered104
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $205
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees68
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
Insurance broker nameSUSAN JOHNSON
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number052671J
Policy instance 1
Insurance contract or identification number052671J
Number of Individuals Covered101
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $548
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number052671J
Policy instance 1
Insurance contract or identification number052671J
Number of Individuals Covered96
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $250
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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