401k Plan data: EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL plan

EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 401k Plan overview

Plan Name	EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL
Plan identification number	001

EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
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

CHATTANOOGA CHRISTIAN SCHOOL has sponsored the creation of one or more 401k plans.

Company Name: CHATTANOOGA CHRISTIAN SCHOOL

Employer identification number (EIN): 620840156

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-08-01 TARA BRYANT 2017-02-28 TARA BRYANT 2017-02-28
001 2014-08-01 TARA BRYANT 2016-05-13 TARA BRYANT 2016-05-13
001 2013-08-01 TARA BRYANT 2015-02-02 TARA BRYANT 2015-02-02
001 2012-08-01 TARA BRYANT TARA BRYANT 2014-05-14
001 2011-08-01 TARA BRYANT TARA BRYANT 2013-05-15
001 2009-08-01 HORACE FEAGANS HORACE FEAGANS 2011-05-13
001 2009-08-01 HORACE W. FEAGANS HORACE W. FEAGANS 2011-05-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2015-08-01	TARA BRYANT	2017-02-28	TARA BRYANT	2017-02-28
001	2014-08-01	TARA BRYANT	2016-05-13	TARA BRYANT	2016-05-13
001	2013-08-01	TARA BRYANT	2015-02-02	TARA BRYANT	2015-02-02
001	2012-08-01	TARA BRYANT		TARA BRYANT	2014-05-14
001	2011-08-01	TARA BRYANT		TARA BRYANT	2013-05-15
001	2009-08-01	HORACE FEAGANS		HORACE FEAGANS	2011-05-13
001	2009-08-01	HORACE W. FEAGANS		HORACE W. FEAGANS	2011-05-12

Plan Statistics for EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL

401k plan membership statisitcs for EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL

Measure Date Value
2012: EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2012 401k membership
Total participants, beginning-of-year 2012-08-01 100
Total number of active participants reported on line 7a of the Form 5500 2012-08-01 66
Number of retired or separated participants receiving benefits 2012-08-01 0
Number of other retired or separated participants entitled to future benefits 2012-08-01 27
Total of all active and inactive participants 2012-08-01 93
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-08-01 0
Total participants 2012-08-01 93
Number of participants with account balances 2012-08-01 93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-08-01 2
2011: EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2011 401k membership
Total participants, beginning-of-year 2011-08-01 104
Total number of active participants reported on line 7a of the Form 5500 2011-08-01 62
Number of retired or separated participants receiving benefits 2011-08-01 0
Number of other retired or separated participants entitled to future benefits 2011-08-01 38
Total of all active and inactive participants 2011-08-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-08-01 0
Total participants 2011-08-01 100
Number of participants with account balances 2011-08-01 100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-08-01 0
2009: EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2009 401k membership
Total participants, beginning-of-year 2009-08-01 111
Total number of active participants reported on line 7a of the Form 5500 2009-08-01 77
Number of retired or separated participants receiving benefits 2009-08-01 0
Number of other retired or separated participants entitled to future benefits 2009-08-01 33
Total of all active and inactive participants 2009-08-01 110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-08-01 0
Total participants 2009-08-01 110
Number of participants with account balances 2009-08-01 110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-08-01 0

Measure	Date	Value
2012: EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2012 401k membership
Total participants, beginning-of-year	2012-08-01	100
Total number of active participants reported on line 7a of the Form 5500	2012-08-01	66
Number of retired or separated participants receiving benefits	2012-08-01	0
Number of other retired or separated participants entitled to future benefits	2012-08-01	27
Total of all active and inactive participants	2012-08-01	93
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-08-01	0
Total participants	2012-08-01	93
Number of participants with account balances	2012-08-01	93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-08-01	2
2011: EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2011 401k membership
Total participants, beginning-of-year	2011-08-01	104
Total number of active participants reported on line 7a of the Form 5500	2011-08-01	62
Number of retired or separated participants receiving benefits	2011-08-01	0
Number of other retired or separated participants entitled to future benefits	2011-08-01	38
Total of all active and inactive participants	2011-08-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-08-01	0
Total participants	2011-08-01	100
Number of participants with account balances	2011-08-01	100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-08-01	0
2009: EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2009 401k membership
Total participants, beginning-of-year	2009-08-01	111
Total number of active participants reported on line 7a of the Form 5500	2009-08-01	77
Number of retired or separated participants receiving benefits	2009-08-01	0
Number of other retired or separated participants entitled to future benefits	2009-08-01	33
Total of all active and inactive participants	2009-08-01	110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-08-01	0
Total participants	2009-08-01	110
Number of participants with account balances	2009-08-01	110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-08-01	0

Financial Data on EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL

Measure	Date	Value
2013 : EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-07-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-07-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-07-31	$0
Total income from all sources (including contributions)	2013-07-31	$330,698
Total loss/gain on sale of assets	2013-07-31	$0
Total of all expenses incurred	2013-07-31	$345,952
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-07-31	$345,614
Expenses. Certain deemed distributions of participant loans	2013-07-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-07-31	$23,298
Value of total assets at end of year	2013-07-31	$2,443,298
Value of total assets at beginning of year	2013-07-31	$2,458,552
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-07-31	$338
Total interest from all sources	2013-07-31	$8,490
Total dividends received (eg from common stock, registered investment company shares)	2013-07-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-07-31	No
Was this plan covered by a fidelity bond	2013-07-31	Yes
Value of fidelity bond cover	2013-07-31	$500,000
If this is an individual account plan, was there a blackout period	2013-07-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-07-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-07-31	No
Contributions received from participants	2013-07-31	$14,106
Participant contributions at end of year	2013-07-31	$19,490
Participant contributions at beginning of year	2013-07-31	$14,202
Income. Received or receivable in cash from other sources (including rollovers)	2013-07-31	$0
Other income not declared elsewhere	2013-07-31	$0
Administrative expenses (other) incurred	2013-07-31	$338
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-07-31	No
Value of net income/loss	2013-07-31	$-15,254
Value of net assets at end of year (total assets less liabilities)	2013-07-31	$2,443,298
Value of net assets at beginning of year (total assets less liabilities)	2013-07-31	$2,458,552
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-07-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-07-31	No
Were any leases to which the plan was party in default or uncollectible	2013-07-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-07-31	$1,822,016
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-07-31	$1,803,025
Interest on participant loans	2013-07-31	$485
Interest earned on other investments	2013-07-31	$8,005
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-07-31	$601,792
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-07-31	$641,325
Expenses. Payments to insurance carriers foe the provision of benefits	2013-07-31	$0
Net investment gain/loss from pooled separate accounts	2013-07-31	$298,910
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-07-31	No
Was there a failure to transmit to the plan any participant contributions	2013-07-31	No
Has the plan failed to provide any benefit when due under the plan	2013-07-31	No
Contributions received in cash from employer	2013-07-31	$9,192
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-07-31	$345,614
Did the plan have assets held for investment	2013-07-31	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	2013-07-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-07-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-07-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-07-31	Disclaimer
Accountancy firm name	2013-07-31	LATTIMORE BLACK MORGAN AND CAIN PC
Accountancy firm EIN	2013-07-31	621199757
2012 : EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-07-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-07-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-07-31	$0
Total income from all sources (including contributions)	2012-07-31	$68,500
Total loss/gain on sale of assets	2012-07-31	$0
Total of all expenses incurred	2012-07-31	$44,981
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-07-31	$44,610
Expenses. Certain deemed distributions of participant loans	2012-07-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-07-31	$11,966
Value of total assets at end of year	2012-07-31	$2,458,552
Value of total assets at beginning of year	2012-07-31	$2,435,033
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-07-31	$371
Total interest from all sources	2012-07-31	$12,211
Total dividends received (eg from common stock, registered investment company shares)	2012-07-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-07-31	No
Was this plan covered by a fidelity bond	2012-07-31	Yes
Value of fidelity bond cover	2012-07-31	$500,000
If this is an individual account plan, was there a blackout period	2012-07-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-07-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-07-31	No
Contributions received from participants	2012-07-31	$7,588
Participant contributions at end of year	2012-07-31	$14,202
Participant contributions at beginning of year	2012-07-31	$19,922
Income. Received or receivable in cash from other sources (including rollovers)	2012-07-31	$0
Other income not declared elsewhere	2012-07-31	$0
Administrative expenses (other) incurred	2012-07-31	$371
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-07-31	No
Value of net income/loss	2012-07-31	$23,519
Value of net assets at end of year (total assets less liabilities)	2012-07-31	$2,458,552
Value of net assets at beginning of year (total assets less liabilities)	2012-07-31	$2,435,033
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-07-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-07-31	No
Were any leases to which the plan was party in default or uncollectible	2012-07-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-07-31	$1,803,025
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-07-31	$1,769,370
Interest on participant loans	2012-07-31	$455
Interest earned on other investments	2012-07-31	$11,756
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-07-31	$641,325
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-07-31	$645,741
Expenses. Payments to insurance carriers foe the provision of benefits	2012-07-31	$0
Net investment gain/loss from pooled separate accounts	2012-07-31	$44,323
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-07-31	No
Was there a failure to transmit to the plan any participant contributions	2012-07-31	No
Has the plan failed to provide any benefit when due under the plan	2012-07-31	No
Contributions received in cash from employer	2012-07-31	$4,378
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-07-31	$44,610
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	2012-07-31	No
Did the plan have assets held for investment	2012-07-31	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	2012-07-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-07-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-07-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-07-31	Disclaimer
Accountancy firm name	2012-07-31	HAZLETT, LEWIS, & BIETER, PLLC
Accountancy firm EIN	2012-07-31	620509553
2011 : EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-07-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-07-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-07-31	$0
Total income from all sources (including contributions)	2011-07-31	$295,462
Total loss/gain on sale of assets	2011-07-31	$0
Total of all expenses incurred	2011-07-31	$150,334
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-07-31	$139,890
Expenses. Certain deemed distributions of participant loans	2011-07-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-07-31	$11,381
Value of total assets at end of year	2011-07-31	$2,435,032
Value of total assets at beginning of year	2011-07-31	$2,289,904
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-07-31	$10,444
Total interest from all sources	2011-07-31	$15,260
Total dividends received (eg from common stock, registered investment company shares)	2011-07-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-07-31	No
Was this plan covered by a fidelity bond	2011-07-31	Yes
Value of fidelity bond cover	2011-07-31	$500,000
If this is an individual account plan, was there a blackout period	2011-07-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-07-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-07-31	No
Contributions received from participants	2011-07-31	$7,031
Participant contributions at end of year	2011-07-31	$19,922
Participant contributions at beginning of year	2011-07-31	$24,503
Income. Received or receivable in cash from other sources (including rollovers)	2011-07-31	$0
Other income not declared elsewhere	2011-07-31	$9,959
Administrative expenses (other) incurred	2011-07-31	$10,444
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-07-31	No
Value of net income/loss	2011-07-31	$145,128
Value of net assets at end of year (total assets less liabilities)	2011-07-31	$2,435,032
Value of net assets at beginning of year (total assets less liabilities)	2011-07-31	$2,289,904
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-07-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-07-31	No
Were any leases to which the plan was party in default or uncollectible	2011-07-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-07-31	$1,769,369
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-07-31	$1,580,190
Interest on participant loans	2011-07-31	$762
Interest earned on other investments	2011-07-31	$14,498
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-07-31	$645,741
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-07-31	$685,211
Expenses. Payments to insurance carriers foe the provision of benefits	2011-07-31	$0
Net investment gain/loss from pooled separate accounts	2011-07-31	$258,862
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-07-31	No
Was there a failure to transmit to the plan any participant contributions	2011-07-31	No
Has the plan failed to provide any benefit when due under the plan	2011-07-31	No
Contributions received in cash from employer	2011-07-31	$4,350
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-07-31	$139,890
Did the plan have assets held for investment	2011-07-31	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	2011-07-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-07-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-07-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-07-31	Disclaimer
Accountancy firm name	2011-07-31	HAZLETT, LEWIS & BIETER, PLLC
Accountancy firm EIN	2011-07-31	620509553
2010 : EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-07-31	$0

Form 5500 Responses for EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL

2012: EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2012 form 5500 responses
2012-08-01	Type of plan entity	Single employer plan
2012-08-01	Submission has been amended	No
2012-08-01	This submission is the final filing	No
2012-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-08-01	Plan is a collectively bargained plan	No
2012-08-01	Plan funding arrangement – Insurance	Yes
2012-08-01	Plan funding arrangement – Trust	Yes
2012-08-01	Plan benefit arrangement – Insurance	Yes
2011: EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2011 form 5500 responses
2011-08-01	Type of plan entity	Single employer plan
2011-08-01	Submission has been amended	No
2011-08-01	This submission is the final filing	No
2011-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-08-01	Plan is a collectively bargained plan	No
2011-08-01	Plan funding arrangement – Insurance	Yes
2011-08-01	Plan funding arrangement – Trust	Yes
2011-08-01	Plan benefit arrangement – Insurance	Yes
2009: EMPLOYEE BENEFIT PLAN OF CHATTANOOGA CHRISTIAN SCHOOL 2009 form 5500 responses
2009-08-01	Type of plan entity	Single employer plan
2009-08-01	Submission has been amended	Yes
2009-08-01	This submission is the final filing	No
2009-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-08-01	Plan is a collectively bargained plan	No
2009-08-01	Plan funding arrangement – Insurance	Yes
2009-08-01	Plan funding arrangement – Trust	Yes
2009-08-01	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

016711C

Policy instance

Insurance contract or identification number	016711C
Number of Individuals Covered	93
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $63
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	19
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	DEENA TURNER

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

Policy contract number

016711C

Policy instance

Insurance contract or identification number	016711C
Number of Individuals Covered	100
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $49
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

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

Policy contract number

016711C

Policy instance

Insurance contract or identification number	016711C
Number of Individuals Covered	104
Insurance policy start date	2010-08-01
Insurance policy end date	2011-07-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $47
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

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Company Name:	CHATTANOOGA CHRISTIAN SCHOOL
Employer identification number (EIN):	620840156
NAIC Classification:	611000