401k Plan data: TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR plan

TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR 401k Plan overview

Plan Name	TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR
Plan identification number	002

TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	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

CATHOLIC SOCIAL SERVICES OF ST. CLAIR has sponsored the creation of one or more 401k plans.

Company Name: CATHOLIC SOCIAL SERVICES OF ST. CLAIR

Employer identification number (EIN): 383171381

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2012-01-01 EDWARD REDLIN 2013-08-21
002 2011-01-01 EDWARD CIESLINSKI EDWARD CIESLINSKI 2012-07-03
002 2009-01-01 PATRICK COGLEY PATRICK COGLEY 2010-10-13
002 2009-01-01 PATRICK COGLEY PATRICK COGLEY 2010-10-13
002 2009-01-01 PATRICK COGLEY PATRICK COGLEY 2010-10-13
002 2009-01-01 PATRICK COGLEY PATRICK COGLEY 2010-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2012-01-01	EDWARD REDLIN	2013-08-21
002	2011-01-01	EDWARD CIESLINSKI		EDWARD CIESLINSKI	2012-07-03
002	2009-01-01	PATRICK COGLEY		PATRICK COGLEY	2010-10-13
002	2009-01-01	PATRICK COGLEY		PATRICK COGLEY	2010-10-13
002	2009-01-01	PATRICK COGLEY		PATRICK COGLEY	2010-10-13
002	2009-01-01	PATRICK COGLEY		PATRICK COGLEY	2010-10-13

Plan Statistics for TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR

Measure Date Value
2011: TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR 2011 401k membership
Total participants, beginning-of-year 2011-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 9
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 6
Total of all active and inactive participants 2011-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 15
Number of participants with account balances 2011-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR 2009 401k membership
Total participants, beginning-of-year 2009-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 10
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 4
Total of all active and inactive participants 2009-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 15
Number of participants with account balances 2009-01-01 15

Measure	Date	Value
2011: TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR 2011 401k membership
Total participants, beginning-of-year	2011-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	9
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	6
Total of all active and inactive participants	2011-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	15
Number of participants with account balances	2011-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR 2009 401k membership
Total participants, beginning-of-year	2009-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	10
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	4
Total of all active and inactive participants	2009-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	15
Number of participants with account balances	2009-01-01	15

Financial Data on TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR

Measure	Date	Value
2011 : TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR 2011 401k financial data
Total income from all sources	2011-12-31	$11,681
Expenses. Total of all expenses incurred	2011-12-31	$1,204
Benefits paid (including direct rollovers)	2011-12-31	$1,022
Total plan assets at end of year	2011-12-31	$257,816
Total plan assets at beginning of year	2011-12-31	$247,339
Total contributions received or receivable from participants	2011-12-31	$12,202
Expenses. Other expenses not covered elsewhere	2011-12-31	$182
Other income received	2011-12-31	$-521
Net income (gross income less expenses)	2011-12-31	$10,477
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$257,816
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$247,339
2010 : TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR 2010 401k financial data
Total income from all sources	2010-12-31	$56,065
Expenses. Total of all expenses incurred	2010-12-31	$47,976
Benefits paid (including direct rollovers)	2010-12-31	$47,776
Total plan assets at end of year	2010-12-31	$247,339
Total plan assets at beginning of year	2010-12-31	$239,250
Total contributions received or receivable from participants	2010-12-31	$31,488
Expenses. Other expenses not covered elsewhere	2010-12-31	$200
Other income received	2010-12-31	$24,577
Net income (gross income less expenses)	2010-12-31	$8,089
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$247,339
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$239,250

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR

2011: TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR 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
2009: TAX DEFERRED ANNUITY PLAN OF CATHOLIC SOCIAL SERVICES OF ST. CLAIR 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

050452J

Policy instance

Insurance contract or identification number	050452J
Number of Individuals Covered	14
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of fees paid to insurance company	USD $110
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

050452J

Policy instance

Insurance contract or identification number	050452J
Number of Individuals Covered	14
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of fees paid to insurance company	USD $79
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	27
Additional information about fees paid to insurance broker	COMPENSATION
Insurance broker organization code?	3
Insurance broker name	CHRISTOPHER SCHUPPE

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Company Name:	CATHOLIC SOCIAL SERVICES OF ST. CLAIR
Employer identification number (EIN):	383171381
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations