401k Plan data: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER plan

TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 401k Plan overview

Plan Name	TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER
Plan identification number	002

TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 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.

401k Sponsoring company profile

CENTRAL BEHAVIORAL HEALTH has sponsored the creation of one or more 401k plans.

Company Name: CENTRAL BEHAVIORAL HEALTH

Employer identification number (EIN): 231548819

NAIC Classification: 621330
NAIC Description: Offices of Mental Health Practitioners (except Physicians)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01 ROBERT LOVE 2016-10-26
002 2015-01-01 ROBERT LOVE
002 2014-01-01 ROBERT LOVE
002 2013-01-01 SHARI VANDERGAST
002 2012-01-01 SHARI VANDERGAST
002 2011-01-01 VERONICA PLOUSIS
002 2010-01-01
002 2009-01-01

Plan Statistics for TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER

Measure Date Value
2015: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2015 401k membership
Total participants, beginning-of-year 2015-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 149
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 21
Total of all active and inactive participants 2015-01-01 170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 170
Number of participants with account balances 2015-01-01 47
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 CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2014 401k membership
Total participants, beginning-of-year 2014-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 125
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 16
Total of all active and inactive participants 2014-01-01 141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 1
Total participants 2014-01-01 142
Number of participants with account balances 2014-01-01 45
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 CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2013 401k membership
Total participants, beginning-of-year 2013-01-01 201
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 30
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 14
Total of all active and inactive participants 2013-01-01 44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 45
Number of participants with account balances 2013-01-01 45
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 CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2012 401k membership
Total participants, beginning-of-year 2012-01-01 220
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 31
Number of other retired or separated participants entitled to future benefits 2012-01-01 16
Total of all active and inactive participants 2012-01-01 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 48
Number of participants with account balances 2012-01-01 48
2011: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2011 401k membership
Total participants, beginning-of-year 2011-01-01 247
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 31
Number of other retired or separated participants entitled to future benefits 2011-01-01 15
Total of all active and inactive participants 2011-01-01 46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 47
Number of participants with account balances 2011-01-01 47
2010: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2010 401k membership
Total participants, beginning-of-year 2010-01-01 222
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 31
Number of other retired or separated participants entitled to future benefits 2010-01-01 16
Total of all active and inactive participants 2010-01-01 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 1
Total participants 2010-01-01 48
Number of participants with account balances 2010-01-01 48
2009: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2009 401k membership
Total participants, beginning-of-year 2009-01-01 227
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 28
Number of other retired or separated participants entitled to future benefits 2009-01-01 15
Total of all active and inactive participants 2009-01-01 43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 44
Number of participants with account balances 2009-01-01 44

Measure	Date	Value
2015: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2015 401k membership
Total participants, beginning-of-year	2015-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	149
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	21
Total of all active and inactive participants	2015-01-01	170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	170
Number of participants with account balances	2015-01-01	47
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 CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2014 401k membership
Total participants, beginning-of-year	2014-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	125
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	16
Total of all active and inactive participants	2014-01-01	141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	1
Total participants	2014-01-01	142
Number of participants with account balances	2014-01-01	45
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 CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2013 401k membership
Total participants, beginning-of-year	2013-01-01	201
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	30
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	14
Total of all active and inactive participants	2013-01-01	44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	45
Number of participants with account balances	2013-01-01	45
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 CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2012 401k membership
Total participants, beginning-of-year	2012-01-01	220
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	31
Number of other retired or separated participants entitled to future benefits	2012-01-01	16
Total of all active and inactive participants	2012-01-01	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	48
Number of participants with account balances	2012-01-01	48
2011: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2011 401k membership
Total participants, beginning-of-year	2011-01-01	247
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	31
Number of other retired or separated participants entitled to future benefits	2011-01-01	15
Total of all active and inactive participants	2011-01-01	46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	47
Number of participants with account balances	2011-01-01	47
2010: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2010 401k membership
Total participants, beginning-of-year	2010-01-01	222
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	31
Number of other retired or separated participants entitled to future benefits	2010-01-01	16
Total of all active and inactive participants	2010-01-01	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	1
Total participants	2010-01-01	48
Number of participants with account balances	2010-01-01	48
2009: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2009 401k membership
Total participants, beginning-of-year	2009-01-01	227
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	28
Number of other retired or separated participants entitled to future benefits	2009-01-01	15
Total of all active and inactive participants	2009-01-01	43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	44
Number of participants with account balances	2009-01-01	44

Financial Data on TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER

Measure	Date	Value
2015 : TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 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	$385,360
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$376,386
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$375,926
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$379,341
Value of total assets at end of year	2015-12-31	$794,861
Value of total assets at beginning of year	2015-12-31	$785,887
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$460
Total interest from all sources	2015-12-31	$15,061
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	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$150,000
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	$73,195
Participant contributions at end of year	2015-12-31	$0
Participant contributions at beginning of year	2015-12-31	$2,857
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$306,146
Administrative expenses (other) incurred	2015-12-31	$460
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	$8,974
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$794,861
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$785,887
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	$247,261
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$276,998
Interest earned on other investments	2015-12-31	$15,061
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$547,600
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$506,032
Net investment gain/loss from pooled separate accounts	2015-12-31	$-9,042
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	$375,926
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	WIPFLI LLP
Accountancy firm EIN	2015-12-31	390758449
2014 : TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 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	$142,769
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$499,063
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$498,511
Expenses. Certain deemed distributions of participant loans	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$94,317
Value of total assets at end of year	2014-12-31	$785,887
Value of total assets at beginning of year	2014-12-31	$1,142,181
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$552
Total interest from all sources	2014-12-31	$15,205
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	$300,000
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	$91,627
Participant contributions at end of year	2014-12-31	$0
Participant contributions at beginning of year	2014-12-31	$0
Participant contributions at end of year	2014-12-31	$2,857
Participant contributions at beginning of year	2014-12-31	$75
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$1,787
Other income not declared elsewhere	2014-12-31	$7
Administrative expenses (other) incurred	2014-12-31	$552
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	$-356,294
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$785,887
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,142,181
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	$276,998
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$600,234
Interest on participant loans	2014-12-31	$0
Interest earned on other investments	2014-12-31	$15,205
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$506,032
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$541,872
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$0
Net investment gain/loss from pooled separate accounts	2014-12-31	$33,240
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$903
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$498,511
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	WIPFLI LLP
Accountancy firm EIN	2014-12-31	390758449
2013 : TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 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	$234,182
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$51,080
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$50,425
Expenses. Certain deemed distributions of participant loans	2013-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$110,376
Value of total assets at end of year	2013-12-31	$1,142,181
Value of total assets at beginning of year	2013-12-31	$959,079
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$655
Total interest from all sources	2013-12-31	$15,580
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	$150,000
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	$110,376
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$0
Other income not declared elsewhere	2013-12-31	$0
Administrative expenses (other) incurred	2013-12-31	$655
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	$183,102
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$1,142,181
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$959,079
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	$600,234
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$436,979
Interest on participant loans	2013-12-31	$0
Interest earned on other investments	2013-12-31	$15,580
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$541,872
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$522,025
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$0
Net investment gain/loss from pooled separate accounts	2013-12-31	$108,226
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
Contributions received in cash from employer	2013-12-31	$0
Employer contributions (assets) at end of year	2013-12-31	$75
Employer contributions (assets) at beginning of year	2013-12-31	$75
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$50,425
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	ELKO & ASSOCIATES, LTD.
Accountancy firm EIN	2013-12-31	233063393
2012 : TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$145,865
Total of all expenses incurred	2012-12-31	$73,360
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$72,765
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$84,519
Value of total assets at end of year	2012-12-31	$959,079
Value of total assets at beginning of year	2012-12-31	$886,574
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$595
Total interest from all sources	2012-12-31	$15,293
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	$150,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$79,341
Participant contributions at end of year	2012-12-31	$75
Participant contributions at beginning of year	2012-12-31	$2,954
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$5,178
Administrative expenses (other) incurred	2012-12-31	$595
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	$72,505
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$959,079
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$886,574
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	$436,979
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$375,768
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$15,293
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$522,025
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$507,852
Net investment gain/loss from pooled separate accounts	2012-12-31	$46,053
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	No
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	$72,765
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
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	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	ELKO & ASSOCIATES LTD.
Accountancy firm EIN	2012-12-31	233063393
2011 : TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$113,365
Total of all expenses incurred	2011-12-31	$151,979
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$151,336
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$110,359
Value of total assets at end of year	2011-12-31	$886,574
Value of total assets at beginning of year	2011-12-31	$925,188
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$643
Total interest from all sources	2011-12-31	$15,866
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	$150,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$80,403
Participant contributions at end of year	2011-12-31	$2,954
Participant contributions at beginning of year	2011-12-31	$7,419
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$29,956
Administrative expenses (other) incurred	2011-12-31	$643
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	$-38,614
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$886,574
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$925,188
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	$375,768
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$381,469
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$15,866
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$507,852
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$536,300
Net investment gain/loss from pooled separate accounts	2011-12-31	$-12,860
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	No
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	$151,336
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
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	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	ELKO & ASSOCIATES, LTD.
Accountancy firm EIN	2011-12-31	233063393
2010 : TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$139,083
Total of all expenses incurred	2010-12-31	$17,728
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$17,077
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$72,331
Value of total assets at end of year	2010-12-31	$925,188
Value of total assets at beginning of year	2010-12-31	$803,833
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$651
Total interest from all sources	2010-12-31	$15,199
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	$150,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$72,331
Participant contributions at end of year	2010-12-31	$7,419
Participant contributions at beginning of year	2010-12-31	$3,821
Administrative expenses (other) incurred	2010-12-31	$651
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	$121,355
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$925,188
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$803,833
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	$381,469
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$305,055
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$15,199
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$536,300
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$494,957
Net investment gain/loss from pooled separate accounts	2010-12-31	$51,553
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	No
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	$17,077
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
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	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	ELKO & ASSOCIATES, LTD.
Accountancy firm EIN	2010-12-31	233063393
2009 : TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2009 401k financial data
Total income from all sources (including contributions)	2009-12-31	$160,469
Total of all expenses incurred	2009-12-31	$189,549
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2009-12-31	$188,940
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2009-12-31	$69,254
Value of total assets at end of year	2009-12-31	$803,833
Value of total assets at beginning of year	2009-12-31	$832,913
Total of administrative expenses incurred including professional, contract, advisory and management fees	2009-12-31	$609
Total interest from all sources	2009-12-31	$14,681
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2009-12-31	No
Was this plan covered by a fidelity bond	2009-12-31	Yes
Value of fidelity bond cover	2009-12-31	$150,000
If this is an individual account plan, was there a blackout period	2009-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2009-12-31	No
Contributions received from participants	2009-12-31	$69,254
Participant contributions at end of year	2009-12-31	$3,821
Participant contributions at beginning of year	2009-12-31	$5,543
Administrative expenses (other) incurred	2009-12-31	$609
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2009-12-31	No
Value of net income/loss	2009-12-31	$-29,080
Value of net assets at end of year (total assets less liabilities)	2009-12-31	$803,833
Value of net assets at beginning of year (total assets less liabilities)	2009-12-31	$832,913
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2009-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2009-12-31	No
Were any leases to which the plan was party in default or uncollectible	2009-12-31	No
Value of interest in pooled separate accounts at end of year	2009-12-31	$305,055
Value of interest in pooled separate accounts at beginning of year	2009-12-31	$367,451
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2009-12-31	$14,681
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2009-12-31	$494,957
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2009-12-31	$459,919
Net investment gain/loss from pooled separate accounts	2009-12-31	$76,534
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2009-12-31	No
Was there a failure to transmit to the plan any participant contributions	2009-12-31	No
Has the plan failed to provide any benefit when due under the plan	2009-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2009-12-31	$188,940
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2009-12-31	No
Did the plan have assets held for investment	2009-12-31	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	2009-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2009-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2009-12-31	No
Opinion of an independent qualified public accountant for this plan	2009-12-31	Disclaimer
Accountancy firm name	2009-12-31	ELKO & ASSOCIATES, LTD.
Accountancy firm EIN	2009-12-31	233063393

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER

2015: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 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 CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 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 CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 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 CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: TAX DEFERRED ANNUITY PLAN OF CENTRAL MONTGOMERY MENTAL HEALTH/MENTAL RETARDATION CENTER 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	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

050227C

Policy instance

Insurance contract or identification number	050227C
Number of Individuals Covered	47
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 $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	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
Amount paid for insurance broker fees	105
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP PROGRAM
Insurance broker organization code?	3
Insurance broker name	PHILADELPHIA REGIONAL OFFICE

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

Policy contract number

050227C

Policy instance

Insurance contract or identification number	050227C
Number of Individuals Covered	45
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 $455
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	455
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	PHILADELPHIA REGIONAL OFFICE

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

Policy contract number

050227C

Policy instance

Insurance contract or identification number	050227C
Number of Individuals Covered	45
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 $125
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	125
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	PHILADELPHIA REGIONAL OFFICE

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

Policy contract number

050227-C

Policy instance

Insurance contract or identification number	050227-C
Number of Individuals Covered	48
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 $154
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	48
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	JOHN CIONCI

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

Policy contract number

050227-C

Policy instance

Insurance contract or identification number	050227-C
Number of Individuals Covered	47
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 $75
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
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

050227-C

Policy instance

Insurance contract or identification number	050227-C
Number of Individuals Covered	48
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 $146
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	48
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ERIC NAPP

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

Policy contract number

050227-C

Policy instance

Insurance contract or identification number	050227-C
Number of Individuals Covered	44
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 $90
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	35
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	MARK MILEWSKI

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Company Name:	CENTRAL BEHAVIORAL HEALTH
Employer identification number (EIN):	231548819
NAIC Classification:	621330
NAIC Description:	Offices of Mental Health Practitioners (except Physicians)

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2016-01-01	ROBERT LOVE	2016-10-26
002	2015-01-01	ROBERT LOVE
002	2014-01-01	ROBERT LOVE
002	2013-01-01	SHARI VANDERGAST
002	2012-01-01	SHARI VANDERGAST
002	2011-01-01	VERONICA PLOUSIS
002	2010-01-01
002	2009-01-01