401k Plan data: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH plan

TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 401k Plan overview

Plan Name	TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH
Plan identification number	003

TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 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 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
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

GIRL SCOUTS HEART OF THE SOUTH has sponsored the creation of one or more 401k plans.

Company Name: GIRL SCOUTS HEART OF THE SOUTH

Employer identification number (EIN): 620502197

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

Additional information about GIRL SCOUTS HEART OF THE SOUTH

Jurisdiction of Incorporation: Mississippi Secretary of State

Incorporation Date:

Company Identification Number: 933241

More information about GIRL SCOUTS HEART OF THE SOUTH

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2022-01-01 CAROL STARR 2023-07-27
003 2021-01-01 CAROL STARR 2022-06-28
003 2020-01-01 CAROL STARR 2021-06-30
003 2019-01-01 CAROL STARR 2020-08-13
003 2018-01-01
003 2017-01-01 DEBBIE MOORE DEBBIE MOORE 2018-10-04
003 2016-01-01 DEBBIE MOORE DEBBIE MOORE 2017-08-24
003 2015-01-01 DEBBIE MOORE DEBBIE MOORE 2016-10-11
003 2014-01-01 DEBBIE MOORE
003 2013-01-01 FABAYO POWELL
003 2012-01-01 FABAYO POWELL
003 2011-01-01 FABAYO POWELL 2012-09-28
003 2010-01-01 FABAYO POWELL 2011-09-26 FABAYO POWELL 2011-09-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2022-01-01	CAROL STARR	2023-07-27
003	2021-01-01	CAROL STARR	2022-06-28
003	2020-01-01	CAROL STARR	2021-06-30
003	2019-01-01	CAROL STARR	2020-08-13
003	2018-01-01
003	2017-01-01	DEBBIE MOORE		DEBBIE MOORE	2018-10-04
003	2016-01-01	DEBBIE MOORE		DEBBIE MOORE	2017-08-24
003	2015-01-01	DEBBIE MOORE		DEBBIE MOORE	2016-10-11
003	2014-01-01	DEBBIE MOORE
003	2013-01-01	FABAYO POWELL
003	2012-01-01	FABAYO POWELL
003	2011-01-01	FABAYO POWELL	2012-09-28
003	2010-01-01	FABAYO POWELL	2011-09-26	FABAYO POWELL	2011-09-26

Plan Statistics for TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH

Measure Date Value
2018: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2018 401k membership
Total participants, beginning-of-year 2018-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 1
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 1
Total of all active and inactive participants 2018-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 2
Number of participants with account balances 2018-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2017 401k membership
Total participants, beginning-of-year 2017-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 1
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 1
Total of all active and inactive participants 2017-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 2
Number of participants with account balances 2017-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2016 401k membership
Total participants, beginning-of-year 2016-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 2
Total of all active and inactive participants 2016-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 3
Number of participants with account balances 2016-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2015 401k membership
Total participants, beginning-of-year 2015-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1
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 2
Total of all active and inactive participants 2015-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 3
Number of participants with account balances 2015-01-01 3
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 GIRL SCOUTS HEART OF THE SOUTH 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1
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 3
Total of all active and inactive participants 2014-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 4
Number of participants with account balances 2014-01-01 4
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 GIRL SCOUTS HEART OF THE SOUTH 2013 401k membership
Total participants, beginning-of-year 2013-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 3
Total of all active and inactive participants 2013-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 5
Number of participants with account balances 2013-01-01 4
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 GIRL SCOUTS HEART OF THE SOUTH 2012 401k membership
Total participants, beginning-of-year 2012-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 4
Total of all active and inactive participants 2012-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 5
Number of participants with account balances 2012-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2018: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2018 401k membership
Total participants, beginning-of-year	2018-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	1
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	1
Total of all active and inactive participants	2018-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	2
Number of participants with account balances	2018-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2017 401k membership
Total participants, beginning-of-year	2017-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	1
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	1
Total of all active and inactive participants	2017-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	2
Number of participants with account balances	2017-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2016 401k membership
Total participants, beginning-of-year	2016-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	2
Total of all active and inactive participants	2016-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	3
Number of participants with account balances	2016-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2015 401k membership
Total participants, beginning-of-year	2015-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1
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	2
Total of all active and inactive participants	2015-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	3
Number of participants with account balances	2015-01-01	3
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 GIRL SCOUTS HEART OF THE SOUTH 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1
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	3
Total of all active and inactive participants	2014-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	4
Number of participants with account balances	2014-01-01	4
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 GIRL SCOUTS HEART OF THE SOUTH 2013 401k membership
Total participants, beginning-of-year	2013-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	3
Total of all active and inactive participants	2013-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	5
Number of participants with account balances	2013-01-01	4
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 GIRL SCOUTS HEART OF THE SOUTH 2012 401k membership
Total participants, beginning-of-year	2012-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	4
Total of all active and inactive participants	2012-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	5
Number of participants with account balances	2012-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH

Measure	Date	Value
2018 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2018 401k financial data
Total income from all sources	2018-12-31	$-237
Expenses. Total of all expenses incurred	2018-12-31	$24
Total plan assets at end of year	2018-12-31	$16,177
Total plan assets at beginning of year	2018-12-31	$16,438
Value of fidelity bond covering the plan	2018-12-31	$2,000,000
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Other income received	2018-12-31	$-237
Net income (gross income less expenses)	2018-12-31	$-261
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$16,177
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$16,438
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$24
2017 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2017 401k financial data
Total income from all sources	2017-12-31	$2,062
Expenses. Total of all expenses incurred	2017-12-31	$441
Benefits paid (including direct rollovers)	2017-12-31	$416
Total plan assets at end of year	2017-12-31	$16,438
Total plan assets at beginning of year	2017-12-31	$14,817
Value of fidelity bond covering the plan	2017-12-31	$2,000,000
Expenses. Other expenses not covered elsewhere	2017-12-31	$25
Other income received	2017-12-31	$2,062
Net income (gross income less expenses)	2017-12-31	$1,621
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$16,438
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$14,817
2016 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2016 401k financial data
Total income from all sources	2016-12-31	$437
Expenses. Total of all expenses incurred	2016-12-31	$28
Total plan assets at end of year	2016-12-31	$14,817
Total plan assets at beginning of year	2016-12-31	$14,408
Value of fidelity bond covering the plan	2016-12-31	$2,000,000
Expenses. Other expenses not covered elsewhere	2016-12-31	$28
Other income received	2016-12-31	$437
Net income (gross income less expenses)	2016-12-31	$409
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$14,817
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$14,408
2015 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2015 401k financial data
Total income from all sources	2015-12-31	$4,709
Expenses. Total of all expenses incurred	2015-12-31	$90,548
Benefits paid (including direct rollovers)	2015-12-31	$90,534
Total plan assets at end of year	2015-12-31	$14,408
Total plan assets at beginning of year	2015-12-31	$100,247
Value of fidelity bond covering the plan	2015-12-31	$2,000,000
Expenses. Other expenses not covered elsewhere	2015-12-31	$14
Other income received	2015-12-31	$4,709
Net income (gross income less expenses)	2015-12-31	$-85,839
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$14,408
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$100,247
2014 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2014 401k financial data
Total income from all sources	2014-12-31	$4,736
Total plan assets at end of year	2014-12-31	$100,247
Total plan assets at beginning of year	2014-12-31	$95,511
Value of fidelity bond covering the plan	2014-12-31	$25,000,000
Other income received	2014-12-31	$4,736
Net income (gross income less expenses)	2014-12-31	$4,736
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$100,247
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$95,511
2013 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2013 401k financial data
Total income from all sources	2013-12-31	$29,648
Expenses. Total of all expenses incurred	2013-12-31	$118,953
Benefits paid (including direct rollovers)	2013-12-31	$118,953
Total plan assets at end of year	2013-12-31	$95,511
Total plan assets at beginning of year	2013-12-31	$184,816
Value of fidelity bond covering the plan	2013-12-31	$25,000,000
Other income received	2013-12-31	$29,648
Net income (gross income less expenses)	2013-12-31	$-89,305
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$95,511
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$184,816
2012 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2012 401k financial data
Total income from all sources	2012-12-31	$21,077
Expenses. Total of all expenses incurred	2012-12-31	$3,577
Benefits paid (including direct rollovers)	2012-12-31	$3,577
Total plan assets at end of year	2012-12-31	$184,816
Total plan assets at beginning of year	2012-12-31	$167,316
Value of fidelity bond covering the plan	2012-12-31	$25,000,000
Other income received	2012-12-31	$21,077
Net income (gross income less expenses)	2012-12-31	$17,500
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$184,816
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$167,316

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH

2018: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 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 funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 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 funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 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 funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS HEART OF THE SOUTH 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 funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

069386-H

Policy instance

Insurance contract or identification number	069386-H
Number of Individuals Covered	2
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
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

069386-H

Policy instance

Insurance contract or identification number	069386-H
Number of Individuals Covered	3
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 $0
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

069386-H

Policy instance

Insurance contract or identification number	069386-H
Number of Individuals Covered	4
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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

069386-H

Policy instance

Insurance contract or identification number	069386-H
Number of Individuals Covered	5
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
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

069386-H

Policy instance

Insurance contract or identification number	069386-H
Number of Individuals Covered	5
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	GIRL SCOUTS HEART OF THE SOUTH
Employer identification number (EIN):	620502197
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	Mississippi Secretary of State
Incorporation Date:
Company Identification Number:	933241