401k Plan data: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. plan

TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 401k Plan overview

Plan Name	TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC.
Plan identification number	002

TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, 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.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

MACOMB FAMILY SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: MACOMB FAMILY SERVICES, INC.

Employer identification number (EIN): 382315965

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2017-01-01 CAROL VARDON OWEN PFAENDTNER 2018-10-09
002 2016-01-01 CAROL VARDON OWEN PFAENDTNER 2017-10-12
002 2015-01-01 CAROL VARDON OWEN PFAENDTNER 2016-10-06
002 2014-01-01 CAROL VARDON OWEN PFAENDTNER 2015-10-12
002 2013-01-01 CAROL VARDON OWEN PFAENDTNER 2014-10-06
002 2012-01-01 CAROL VARDON OWEN PFAENDTNER 2013-10-14
002 2011-01-01 CAROL VARDON
002 2010-01-01 OWEN PFAENDTNER
002 2009-01-01 OWEN PFAENDTNER

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2017-01-01	CAROL VARDON	OWEN PFAENDTNER	2018-10-09
002	2016-01-01	CAROL VARDON	OWEN PFAENDTNER	2017-10-12
002	2015-01-01	CAROL VARDON	OWEN PFAENDTNER	2016-10-06
002	2014-01-01	CAROL VARDON	OWEN PFAENDTNER	2015-10-12
002	2013-01-01	CAROL VARDON	OWEN PFAENDTNER	2014-10-06
002	2012-01-01	CAROL VARDON	OWEN PFAENDTNER	2013-10-14
002	2011-01-01	CAROL VARDON
002	2010-01-01	OWEN PFAENDTNER
002	2009-01-01	OWEN PFAENDTNER

Plan Statistics for TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC.

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC.

Measure Date Value
2017: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2017 401k membership
Total participants, beginning-of-year 2017-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 4
Number of other retired or separated participants entitled to future benefits 2017-01-01 3
Total of all active and inactive participants 2017-01-01 7
Total participants 2017-01-01 7
Number of participants with account balances 2017-01-01 7
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 FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2016 401k membership
Total participants, beginning-of-year 2016-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 148
Number of other retired or separated participants entitled to future benefits 2016-01-01 3
Total of all active and inactive participants 2016-01-01 151
Total participants 2016-01-01 151
Number of participants with account balances 2016-01-01 9
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 FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 168
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 152
Number of other retired or separated participants entitled to future benefits 2015-01-01 3
Total of all active and inactive participants 2015-01-01 155
Total participants 2015-01-01 155
Number of participants with account balances 2015-01-01 10
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 FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 170
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 165
Number of other retired or separated participants entitled to future benefits 2014-01-01 3
Total of all active and inactive participants 2014-01-01 168
Total participants 2014-01-01 168
Number of participants with account balances 2014-01-01 11
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 FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 186
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 166
Number of other retired or separated participants entitled to future benefits 2013-01-01 4
Total of all active and inactive participants 2013-01-01 170
Total participants 2013-01-01 170
Number of participants with account balances 2013-01-01 11
2012: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2012 401k membership
Total participants, beginning-of-year 2012-01-01 178
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 182
Number of other retired or separated participants entitled to future benefits 2012-01-01 4
Total of all active and inactive participants 2012-01-01 186
Total participants 2012-01-01 186
Number of participants with account balances 2012-01-01 13
2011: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2011 401k membership
Total participants, beginning-of-year 2011-01-01 168
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 176
Number of other retired or separated participants entitled to future benefits 2011-01-01 2
Total of all active and inactive participants 2011-01-01 178
Total participants 2011-01-01 178
Number of participants with account balances 2011-01-01 13
2010: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2010 401k membership
Total participants, beginning-of-year 2010-01-01 180
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 166
Number of other retired or separated participants entitled to future benefits 2010-01-01 2
Total of all active and inactive participants 2010-01-01 168
Total participants 2010-01-01 168
Number of participants with account balances 2010-01-01 10
2009: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2009 401k membership
Total participants, beginning-of-year 2009-01-01 176
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 176
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 3
Total of all active and inactive participants 2009-01-01 180
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 180
Number of participants with account balances 2009-01-01 10

Measure	Date	Value
2017: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2017 401k membership
Total participants, beginning-of-year	2017-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	4
Number of other retired or separated participants entitled to future benefits	2017-01-01	3
Total of all active and inactive participants	2017-01-01	7
Total participants	2017-01-01	7
Number of participants with account balances	2017-01-01	7
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 FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2016 401k membership
Total participants, beginning-of-year	2016-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	148
Number of other retired or separated participants entitled to future benefits	2016-01-01	3
Total of all active and inactive participants	2016-01-01	151
Total participants	2016-01-01	151
Number of participants with account balances	2016-01-01	9
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 FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	168
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	152
Number of other retired or separated participants entitled to future benefits	2015-01-01	3
Total of all active and inactive participants	2015-01-01	155
Total participants	2015-01-01	155
Number of participants with account balances	2015-01-01	10
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 FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	170
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	165
Number of other retired or separated participants entitled to future benefits	2014-01-01	3
Total of all active and inactive participants	2014-01-01	168
Total participants	2014-01-01	168
Number of participants with account balances	2014-01-01	11
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 FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	186
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	166
Number of other retired or separated participants entitled to future benefits	2013-01-01	4
Total of all active and inactive participants	2013-01-01	170
Total participants	2013-01-01	170
Number of participants with account balances	2013-01-01	11
2012: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	178
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	182
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	186
Total participants	2012-01-01	186
Number of participants with account balances	2012-01-01	13
2011: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2011 401k membership
Total participants, beginning-of-year	2011-01-01	168
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	176
Number of other retired or separated participants entitled to future benefits	2011-01-01	2
Total of all active and inactive participants	2011-01-01	178
Total participants	2011-01-01	178
Number of participants with account balances	2011-01-01	13
2010: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2010 401k membership
Total participants, beginning-of-year	2010-01-01	180
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	166
Number of other retired or separated participants entitled to future benefits	2010-01-01	2
Total of all active and inactive participants	2010-01-01	168
Total participants	2010-01-01	168
Number of participants with account balances	2010-01-01	10
2009: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2009 401k membership
Total participants, beginning-of-year	2009-01-01	176
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	176
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	180
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	180
Number of participants with account balances	2009-01-01	10

Financial Data on TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC.

Measure	Date	Value
2017 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$12,157
Total of all expenses incurred	2017-12-31	$20,242
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$20,111
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,865
Value of total assets at end of year	2017-12-31	$159,954
Value of total assets at beginning of year	2017-12-31	$168,039
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$131
Total interest from all sources	2017-12-31	$3,519
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2017-12-31	$0
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$150,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$1,865
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	$-8,085
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$159,954
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$168,039
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
Investment advisory and management fees	2017-12-31	$131
Value of interest in pooled separate accounts at end of year	2017-12-31	$37,273
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$48,639
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$3,519
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$122,681
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$119,400
Net investment gain/loss from pooled separate accounts	2017-12-31	$6,773
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$20,111
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	2017-12-31	No
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	WEINLANDER FITZHUGH
Accountancy firm EIN	2017-12-31	382272300
2016 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2016 401k financial data
Total income from all sources (including contributions)	2016-12-31	$87,091
Total of all expenses incurred	2016-12-31	$24,082
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$23,919
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$79,999
Value of total assets at end of year	2016-12-31	$168,039
Value of total assets at beginning of year	2016-12-31	$105,030
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$163
Total interest from all sources	2016-12-31	$1,915
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	$150,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$20,473
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$1,666
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$59,526
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	$63,009
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$168,039
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$105,030
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
Investment advisory and management fees	2016-12-31	$163
Value of interest in pooled separate accounts at end of year	2016-12-31	$48,639
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$62,539
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$1,915
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$119,400
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$40,825
Net investment gain/loss from pooled separate accounts	2016-12-31	$5,177
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$23,919
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	2016-12-31	No
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	WEINLANDER FITZHUGH
Accountancy firm EIN	2016-12-31	382272300
2015 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$9,661
Total of all expenses incurred	2015-12-31	$27,340
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$27,188
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$9,328
Value of total assets at end of year	2015-12-31	$105,030
Value of total assets at beginning of year	2015-12-31	$122,709
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$152
Total interest from all sources	2015-12-31	$777
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	$150,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$9,328
Participant contributions at end of year	2015-12-31	$1,666
Participant contributions at beginning of year	2015-12-31	$133
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	$-17,679
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$105,030
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$122,709
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
Investment advisory and management fees	2015-12-31	$152
Value of interest in pooled separate accounts at end of year	2015-12-31	$62,539
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$85,133
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$777
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$40,825
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$37,443
Net investment gain/loss from pooled separate accounts	2015-12-31	$-444
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$27,188
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	2015-12-31	No
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	WEINLANDER FITZHUGH
Accountancy firm EIN	2015-12-31	382272300
2014 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2014 401k financial data
Total income from all sources (including contributions)	2014-12-31	$17,661
Total of all expenses incurred	2014-12-31	$11,920
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$11,748
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$11,083
Value of total assets at end of year	2014-12-31	$122,709
Value of total assets at beginning of year	2014-12-31	$116,968
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$172
Total interest from all sources	2014-12-31	$964
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	$150,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$11,083
Participant contributions at end of year	2014-12-31	$133
Participant contributions at beginning of year	2014-12-31	$519
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	$5,741
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$122,709
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$116,968
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
Investment advisory and management fees	2014-12-31	$172
Value of interest in pooled separate accounts at end of year	2014-12-31	$85,133
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$76,592
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$964
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$37,443
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$39,857
Net investment gain/loss from pooled separate accounts	2014-12-31	$5,614
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$11,748
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	2014-12-31	No
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	WEINLANDER FITZHUGH
Accountancy firm EIN	2014-12-31	382272300
2013 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2013 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$258
Total income from all sources (including contributions)	2013-12-31	$26,931
Total of all expenses incurred	2013-12-31	$5,327
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$5,161
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$12,540
Value of total assets at end of year	2013-12-31	$116,968
Value of total assets at beginning of year	2013-12-31	$95,622
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$166
Total interest from all sources	2013-12-31	$1,005
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
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$12,540
Participant contributions at end of year	2013-12-31	$519
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$258
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	$21,604
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$116,968
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$95,364
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 pooled separate accounts at end of year	2013-12-31	$76,592
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$63,999
Interest earned on other investments	2013-12-31	$1,005
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$39,857
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$31,623
Net investment gain/loss from pooled separate accounts	2013-12-31	$13,386
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	$5,161
Contract administrator fees	2013-12-31	$166
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	CENKO, VENDITTELLI & HAYNES, PLC
Accountancy firm EIN	2013-12-31	810584482
2012 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$258
Total income from all sources (including contributions)	2012-12-31	$41,698
Total of all expenses incurred	2012-12-31	$215,842
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$215,681
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$12,496
Value of total assets at end of year	2012-12-31	$95,622
Value of total assets at beginning of year	2012-12-31	$269,508
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$161
Total interest from all sources	2012-12-31	$1,088
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	$12,496
Participant contributions at beginning of year	2012-12-31	$60
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$258
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	$-174,144
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$95,364
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$269,508
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	$63,999
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$211,916
Interest earned on other investments	2012-12-31	$1,088
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$31,623
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$57,532
Net investment gain/loss from pooled separate accounts	2012-12-31	$28,114
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	$215,681
Contract administrator fees	2012-12-31	$161
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	CENKO, VENDITTELLI & HAYNES, PLC
Accountancy firm EIN	2012-12-31	810584482
2011 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2011 401k financial data
Total income from all sources (including contributions)	2011-12-31	$13,250
Total of all expenses incurred	2011-12-31	$168
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$21,803
Value of total assets at end of year	2011-12-31	$269,508
Value of total assets at beginning of year	2011-12-31	$256,426
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$168
Total interest from all sources	2011-12-31	$1,464
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	$21,803
Participant contributions at end of year	2011-12-31	$60
Participant contributions at beginning of year	2011-12-31	$1,636
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$114
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	$13,082
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$269,508
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$256,426
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	$211,916
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$215,396
Interest earned on other investments	2011-12-31	$1,464
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$57,532
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$39,280
Net investment gain/loss from pooled separate accounts	2011-12-31	$-10,017
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
Contract administrator fees	2011-12-31	$168
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	COHNREZNICK LLP
Accountancy firm EIN	2011-12-31	221478099
2010 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$50,360
Total of all expenses incurred	2010-12-31	$701
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$521
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$21,958
Value of total assets at end of year	2010-12-31	$256,426
Value of total assets at beginning of year	2010-12-31	$206,767
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$180
Total interest from all sources	2010-12-31	$1,079
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
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$21,958
Participant contributions at end of year	2010-12-31	$1,636
Participant contributions at beginning of year	2010-12-31	$823
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$114
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$38
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	$49,659
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$256,426
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$206,767
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	$215,396
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$172,140
Interest earned on other investments	2010-12-31	$1,079
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$39,280
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$33,766
Net investment gain/loss from pooled separate accounts	2010-12-31	$27,323
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	$521
Contract administrator fees	2010-12-31	$180
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	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	J.H. COHN LLP
Accountancy firm EIN	2010-12-31	221478099
2009 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC.

2017: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF MACOMB FAMILY SERVICES, INC. 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	This submission is the final filing	No
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

712056-D

Policy instance

Insurance contract or identification number	712056-D
Number of Individuals Covered	7
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 $0
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
Insurance broker organization code?	3
Insurance broker name	SOUTHFIELD REGIONAL OFFICE

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

Policy contract number

712056-D

Policy instance

Insurance contract or identification number	712056-D
Number of Individuals Covered	10
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 $11
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	11
Insurance broker organization code?	3
Insurance broker name	SOUTHFIELD REGIONAL OFFICE

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

Policy contract number

712056-D

Policy instance

Insurance contract or identification number	712056-D
Number of Individuals Covered	11
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 $0
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
Insurance broker organization code?	3
Insurance broker name	SOUTHFIELD REGIONAL OFFICE

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

Policy contract number

712056-D

Policy instance

Insurance contract or identification number	712056-D
Number of Individuals Covered	12
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of fees paid to insurance company	USD $19
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	19
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP PROGRAM
Insurance broker organization code?	3
Insurance broker name	SOUTHFIELD REGIONAL OFFICE

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

Policy contract number

712056-D

Policy instance

Insurance contract or identification number	712056-D
Number of Individuals Covered	13
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $20
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	9
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP PROGRAM
Insurance broker organization code?	3
Insurance broker name	ANTHONY ROGALSKI

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

Policy contract number

712-056-D

Policy instance

Insurance contract or identification number	712-056-D
Number of Individuals Covered	13
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $168
Total amount of fees paid to insurance company	USD $0
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

712-056-D

Policy instance

Insurance contract or identification number	712-056-D
Number of Individuals Covered	10
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 $180
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

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Company Name:	MACOMB FAMILY SERVICES, INC.
Employer identification number (EIN):	382315965
NAIC Classification:	624100
NAIC Description:	Individual and Family Services