401k Plan data: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON plan

TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 401k Plan overview

Plan Name	TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON
Plan identification number	003

TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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 OF WESTERN WASHINGTON has sponsored the creation of one or more 401k plans.

Company Name: GIRL SCOUTS OF WESTERN WASHINGTON

Employer identification number (EIN): 916060940

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

Additional information about GIRL SCOUTS OF WESTERN WASHINGTON

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1964-01-22

Company Identification Number: 601080755

Legal Registered Office Address: 5601 6TH AVE S STE 150

SEATTLE
United States of America (USA)
981082556

More information about GIRL SCOUTS OF WESTERN WASHINGTON

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2021-10-01
003 2020-10-01
003 2019-10-01
003 2019-10-01
003 2019-10-01
003 2018-10-01
003 2018-10-01
003 2018-10-01
003 2018-10-01
003 2017-10-01 DOUGLAS I KIMURA DOUGLAS I KIMURA 2018-07-13
003 2017-10-01
003 2017-10-01
003 2017-10-01
003 2017-10-01
003 2017-10-01
003 2016-10-01 DOUGLAS KIMURA DOUGLAS KIMURA 2018-07-16
003 2015-10-01 DOUGLAS KIMURA 2017-01-19
003 2014-10-01 DOUG KIMURA 2016-06-30 DOUG KIMURA 2016-06-30
003 2014-01-01 DOUGLAS KIMURA 2017-01-19
003 2013-01-01 DOUGLAS KIMURA 2014-05-21
003 2012-01-01 DOUGLAS KIMURA 2014-05-21
003 2011-01-01 DOUGLAS I KIMURA 2012-07-31
003 2010-01-01 DOUG KIMURA 2011-07-14 DOUG KIMURA 2011-07-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2021-10-01
003	2020-10-01
003	2019-10-01
003	2019-10-01
003	2019-10-01
003	2018-10-01
003	2018-10-01
003	2018-10-01
003	2018-10-01
003	2017-10-01	DOUGLAS I KIMURA		DOUGLAS I KIMURA	2018-07-13
003	2017-10-01
003	2017-10-01
003	2017-10-01
003	2017-10-01
003	2017-10-01
003	2016-10-01	DOUGLAS KIMURA		DOUGLAS KIMURA	2018-07-16
003	2015-10-01	DOUGLAS KIMURA	2017-01-19
003	2014-10-01	DOUG KIMURA	2016-06-30	DOUG KIMURA	2016-06-30
003	2014-01-01	DOUGLAS KIMURA	2017-01-19
003	2013-01-01	DOUGLAS KIMURA	2014-05-21
003	2012-01-01	DOUGLAS KIMURA	2014-05-21
003	2011-01-01	DOUGLAS I KIMURA	2012-07-31
003	2010-01-01	DOUG KIMURA	2011-07-14	DOUG KIMURA	2011-07-14

Plan Statistics for TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON

Measure Date Value
2021: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2021 401k membership
Total participants, beginning-of-year 2021-10-01 203
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 126
Number of retired or separated participants receiving benefits 2021-10-01 0
Number of other retired or separated participants entitled to future benefits 2021-10-01 107
Total of all active and inactive participants 2021-10-01 233
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-10-01 0
Total participants 2021-10-01 233
Number of participants with account balances 2021-10-01 146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-10-01 4
2020: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2020 401k membership
Total participants, beginning-of-year 2020-10-01 202
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 85
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 118
Total of all active and inactive participants 2020-10-01 203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-10-01 0
Total participants 2020-10-01 203
Number of participants with account balances 2020-10-01 165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-10-01 3
2019: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2019 401k membership
Total participants, beginning-of-year 2019-10-01 139
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 89
Number of retired or separated participants receiving benefits 2019-10-01 0
Number of other retired or separated participants entitled to future benefits 2019-10-01 113
Total of all active and inactive participants 2019-10-01 202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-10-01 0
Total participants 2019-10-01 202
Number of participants with account balances 2019-10-01 159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-10-01 12
2018: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2018 401k membership
Total participants, beginning-of-year 2018-10-01 139
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 63
Number of retired or separated participants receiving benefits 2018-10-01 0
Number of other retired or separated participants entitled to future benefits 2018-10-01 76
Total of all active and inactive participants 2018-10-01 139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-10-01 0
Total participants 2018-10-01 139
Number of participants with account balances 2018-10-01 138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-10-01 6
2017: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2017 401k membership
Total participants, beginning-of-year 2017-10-01 117
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 79
Number of retired or separated participants receiving benefits 2017-10-01 0
Number of other retired or separated participants entitled to future benefits 2017-10-01 59
Total of all active and inactive participants 2017-10-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-10-01 0
Total participants 2017-10-01 138
Number of participants with account balances 2017-10-01 135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-10-01 2
2016: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2016 401k membership
Total participants, beginning-of-year 2016-10-01 117
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 79
Number of retired or separated participants receiving benefits 2016-10-01 0
Number of other retired or separated participants entitled to future benefits 2016-10-01 59
Total of all active and inactive participants 2016-10-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-10-01 0
Total participants 2016-10-01 138
Number of participants with account balances 2016-10-01 135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-10-01 2

Measure	Date	Value
2021: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2021 401k membership
Total participants, beginning-of-year	2021-10-01	203
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	126
Number of retired or separated participants receiving benefits	2021-10-01	0
Number of other retired or separated participants entitled to future benefits	2021-10-01	107
Total of all active and inactive participants	2021-10-01	233
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-10-01	0
Total participants	2021-10-01	233
Number of participants with account balances	2021-10-01	146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-10-01	4
2020: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2020 401k membership
Total participants, beginning-of-year	2020-10-01	202
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	85
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	118
Total of all active and inactive participants	2020-10-01	203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-10-01	0
Total participants	2020-10-01	203
Number of participants with account balances	2020-10-01	165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-10-01	3
2019: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2019 401k membership
Total participants, beginning-of-year	2019-10-01	139
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	89
Number of retired or separated participants receiving benefits	2019-10-01	0
Number of other retired or separated participants entitled to future benefits	2019-10-01	113
Total of all active and inactive participants	2019-10-01	202
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-10-01	0
Total participants	2019-10-01	202
Number of participants with account balances	2019-10-01	159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-10-01	12
2018: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2018 401k membership
Total participants, beginning-of-year	2018-10-01	139
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	63
Number of retired or separated participants receiving benefits	2018-10-01	0
Number of other retired or separated participants entitled to future benefits	2018-10-01	76
Total of all active and inactive participants	2018-10-01	139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-10-01	0
Total participants	2018-10-01	139
Number of participants with account balances	2018-10-01	138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-10-01	6
2017: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2017 401k membership
Total participants, beginning-of-year	2017-10-01	117
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	79
Number of retired or separated participants receiving benefits	2017-10-01	0
Number of other retired or separated participants entitled to future benefits	2017-10-01	59
Total of all active and inactive participants	2017-10-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-10-01	0
Total participants	2017-10-01	138
Number of participants with account balances	2017-10-01	135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-10-01	2
2016: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2016 401k membership
Total participants, beginning-of-year	2016-10-01	117
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	79
Number of retired or separated participants receiving benefits	2016-10-01	0
Number of other retired or separated participants entitled to future benefits	2016-10-01	59
Total of all active and inactive participants	2016-10-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-10-01	0
Total participants	2016-10-01	138
Number of participants with account balances	2016-10-01	135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-10-01	2

Financial Data on TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON

Measure	Date	Value
2022 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2022-09-30	$0
Total unrealized appreciation/depreciation of assets	2022-09-30	$0
Total transfer of assets to this plan	2022-09-30	$22,715
Total transfer of assets from this plan	2022-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-09-30	$0
Total income from all sources (including contributions)	2022-09-30	$-2,155,777
Total loss/gain on sale of assets	2022-09-30	$0
Total of all expenses incurred	2022-09-30	$357,349
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-09-30	$356,993
Expenses. Certain deemed distributions of participant loans	2022-09-30	$0
Value of total corrective distributions	2022-09-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-09-30	$311,682
Value of total assets at end of year	2022-09-30	$2,198,496
Value of total assets at beginning of year	2022-09-30	$4,688,907
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-09-30	$356
Total interest from all sources	2022-09-30	$1,030
Total dividends received (eg from common stock, registered investment company shares)	2022-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-09-30	$0
Assets. Real estate other than employer real property at end of year	2022-09-30	$0
Assets. Real estate other than employer real property at beginning of year	2022-09-30	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2022-09-30	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2022-09-30	$0
Was this plan covered by a fidelity bond	2022-09-30	Yes
Value of fidelity bond cover	2022-09-30	$1,000,000
If this is an individual account plan, was there a blackout period	2022-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2022-09-30	No
Contributions received from participants	2022-09-30	$259,418
Participant contributions at end of year	2022-09-30	$0
Participant contributions at beginning of year	2022-09-30	$0
Participant contributions at end of year	2022-09-30	$0
Participant contributions at beginning of year	2022-09-30	$0
Assets. Other investments not covered elsewhere at end of year	2022-09-30	$0
Assets. Other investments not covered elsewhere at beginning of year	2022-09-30	$0
Income. Received or receivable in cash from other sources (including rollovers)	2022-09-30	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-09-30	$0
Assets. Loans (other than to participants) at end of year	2022-09-30	$0
Assets. Loans (other than to participants) at beginning of year	2022-09-30	$0
Other income not declared elsewhere	2022-09-30	$0
Administrative expenses (other) incurred	2022-09-30	$356
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-09-30	No
Income. Non cash contributions	2022-09-30	$0
Value of net income/loss	2022-09-30	$-2,513,126
Value of net assets at end of year (total assets less liabilities)	2022-09-30	$2,198,496
Value of net assets at beginning of year (total assets less liabilities)	2022-09-30	$4,688,907
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-09-30	No
Were any leases to which the plan was party in default or uncollectible	2022-09-30	No
Assets. partnership/joint venture interests at end of year	2022-09-30	$0
Assets. partnership/joint venture interests at beginning of year	2022-09-30	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-09-30	$1,942,450
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-09-30	$4,331,112
Value of interest in pooled separate accounts at end of year	2022-09-30	$0
Value of interest in pooled separate accounts at beginning of year	2022-09-30	$0
Interest on participant loans	2022-09-30	$0
Income. Interest from loans (other than to participants)	2022-09-30	$0
Interest earned on other investments	2022-09-30	$1,030
Income. Interest from US Government securities	2022-09-30	$0
Income. Interest from corporate debt instruments	2022-09-30	$0
Value of interest in master investment trust accounts at end of year	2022-09-30	$0
Value of interest in master investment trust accounts at beginning of year	2022-09-30	$0
Value of interest in common/collective trusts at end of year	2022-09-30	$0
Value of interest in common/collective trusts at beginning of year	2022-09-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-09-30	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-09-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-09-30	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-09-30	$0
Assets. Value of investments in 103.12 investment entities at end of year	2022-09-30	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2022-09-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-09-30	$256,046
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-09-30	$357,795
Expenses. Payments to insurance carriers foe the provision of benefits	2022-09-30	$0
Asset value of US Government securities at end of year	2022-09-30	$0
Asset value of US Government securities at beginning of year	2022-09-30	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-09-30	$0
Net investment gain/loss from pooled separate accounts	2022-09-30	$-2,468,489
Net investment gain or loss from common/collective trusts	2022-09-30	$0
Net gain/loss from 103.12 investment entities	2022-09-30	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-09-30	No
Was there a failure to transmit to the plan any participant contributions	2022-09-30	No
Has the plan failed to provide any benefit when due under the plan	2022-09-30	No
Contributions received in cash from employer	2022-09-30	$52,264
Employer contributions (assets) at end of year	2022-09-30	$0
Employer contributions (assets) at beginning of year	2022-09-30	$0
Income. Dividends from preferred stock	2022-09-30	$0
Income. Dividends from common stock	2022-09-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-09-30	$356,993
Asset. Corporate debt instrument preferred debt at end of year	2022-09-30	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2022-09-30	$0
Asset. Corporate debt instrument debt (other) at end of year	2022-09-30	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2022-09-30	$0
Assets. Corporate common stocks other than exployer securities at end of year	2022-09-30	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2022-09-30	$0
Did the plan have assets held for investment	2022-09-30	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	2022-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-09-30	No
Aggregate proceeds on sale of assets	2022-09-30	$0
Aggregate carrying amount (costs) on sale of assets	2022-09-30	$0
2021 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-09-30	$0
Total income from all sources (including contributions)	2021-09-30	$1,377,045
Total loss/gain on sale of assets	2021-09-30	$0
Total of all expenses incurred	2021-09-30	$880,607
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-09-30	$879,734
Expenses. Certain deemed distributions of participant loans	2021-09-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-09-30	$468,284
Value of total assets at end of year	2021-09-30	$4,688,907
Value of total assets at beginning of year	2021-09-30	$4,192,469
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-09-30	$873
Total interest from all sources	2021-09-30	$6,183
Total dividends received (eg from common stock, registered investment company shares)	2021-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-09-30	No
Was this plan covered by a fidelity bond	2021-09-30	Yes
Value of fidelity bond cover	2021-09-30	$1,000,000
If this is an individual account plan, was there a blackout period	2021-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2021-09-30	No
Contributions received from participants	2021-09-30	$260,790
Income. Received or receivable in cash from other sources (including rollovers)	2021-09-30	$166,077
Other income not declared elsewhere	2021-09-30	$0
Administrative expenses (other) incurred	2021-09-30	$873
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-09-30	No
Value of net income/loss	2021-09-30	$496,438
Value of net assets at end of year (total assets less liabilities)	2021-09-30	$4,688,907
Value of net assets at beginning of year (total assets less liabilities)	2021-09-30	$4,192,469
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-09-30	No
Were any leases to which the plan was party in default or uncollectible	2021-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-09-30	$4,331,112
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-09-30	$3,643,749
Interest on participant loans	2021-09-30	$0
Interest earned on other investments	2021-09-30	$6,183
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-09-30	$357,795
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-09-30	$548,720
Expenses. Payments to insurance carriers foe the provision of benefits	2021-09-30	$0
Net investment gain/loss from pooled separate accounts	2021-09-30	$902,578
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-09-30	No
Was there a failure to transmit to the plan any participant contributions	2021-09-30	No
Has the plan failed to provide any benefit when due under the plan	2021-09-30	No
Contributions received in cash from employer	2021-09-30	$41,417
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-09-30	$879,734
Did the plan have assets held for investment	2021-09-30	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	2021-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-09-30	No
Opinion of an independent qualified public accountant for this plan	2021-09-30	Disclaimer
2020 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-09-30	$0
Total income from all sources (including contributions)	2020-09-30	$803,717
Total loss/gain on sale of assets	2020-09-30	$0
Total of all expenses incurred	2020-09-30	$235,185
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-09-30	$234,291
Expenses. Certain deemed distributions of participant loans	2020-09-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-09-30	$410,926
Value of total assets at end of year	2020-09-30	$4,251,496
Value of total assets at beginning of year	2020-09-30	$3,677,717
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-09-30	$894
Total interest from all sources	2020-09-30	$9,424
Total dividends received (eg from common stock, registered investment company shares)	2020-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-09-30	No
Was this plan covered by a fidelity bond	2020-09-30	No
Value of fidelity bond cover	2020-09-30	$1,000,000
If this is an individual account plan, was there a blackout period	2020-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2020-09-30	No
Contributions received from participants	2020-09-30	$271,374
Income. Received or receivable in cash from other sources (including rollovers)	2020-09-30	$55,172
Other income not declared elsewhere	2020-09-30	$4,884
Administrative expenses (other) incurred	2020-09-30	$894
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-09-30	No
Value of net income/loss	2020-09-30	$568,532
Value of net assets at end of year (total assets less liabilities)	2020-09-30	$4,251,496
Value of net assets at beginning of year (total assets less liabilities)	2020-09-30	$3,677,717
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-09-30	No
Were any leases to which the plan was party in default or uncollectible	2020-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-09-30	$3,643,749
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-09-30	$3,064,102
Interest on participant loans	2020-09-30	$0
Interest earned on other investments	2020-09-30	$9,424
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-09-30	$548,720
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-09-30	$559,835
Expenses. Payments to insurance carriers foe the provision of benefits	2020-09-30	$0
Net investment gain/loss from pooled separate accounts	2020-09-30	$378,483
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-09-30	No
Was there a failure to transmit to the plan any participant contributions	2020-09-30	Yes
Has the plan failed to provide any benefit when due under the plan	2020-09-30	No
Contributions received in cash from employer	2020-09-30	$84,380
Employer contributions (assets) at end of year	2020-09-30	$59,027
Employer contributions (assets) at beginning of year	2020-09-30	$53,780
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-09-30	$234,291
Did the plan have assets held for investment	2020-09-30	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	2020-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2020-09-30	Disclaimer
Accountancy firm name	2020-09-30	CLARK NUMBER, P.S.
Accountancy firm EIN	2020-09-30	911194016
2019 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-09-30	$0
Total income from all sources (including contributions)	2019-09-30	$439,098
Total loss/gain on sale of assets	2019-09-30	$0
Total of all expenses incurred	2019-09-30	$183,818
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-09-30	$182,955
Expenses. Certain deemed distributions of participant loans	2019-09-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-09-30	$363,314
Value of total assets at end of year	2019-09-30	$3,682,964
Value of total assets at beginning of year	2019-09-30	$3,427,684
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-09-30	$863
Total interest from all sources	2019-09-30	$11,151
Total dividends received (eg from common stock, registered investment company shares)	2019-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-09-30	No
Was this plan covered by a fidelity bond	2019-09-30	Yes
Value of fidelity bond cover	2019-09-30	$1,000,000
If this is an individual account plan, was there a blackout period	2019-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2019-09-30	No
Contributions received from participants	2019-09-30	$299,543
Income. Received or receivable in cash from other sources (including rollovers)	2019-09-30	$4,744
Other income not declared elsewhere	2019-09-30	$0
Administrative expenses (other) incurred	2019-09-30	$863
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-09-30	No
Value of net income/loss	2019-09-30	$255,280
Value of net assets at end of year (total assets less liabilities)	2019-09-30	$3,682,964
Value of net assets at beginning of year (total assets less liabilities)	2019-09-30	$3,427,684
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-09-30	No
Were any leases to which the plan was party in default or uncollectible	2019-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-09-30	$3,064,102
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-09-30	$2,836,163
Interest on participant loans	2019-09-30	$0
Interest earned on other investments	2019-09-30	$11,151
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-09-30	$559,835
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-09-30	$537,741
Expenses. Payments to insurance carriers foe the provision of benefits	2019-09-30	$0
Net investment gain/loss from pooled separate accounts	2019-09-30	$64,633
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-09-30	No
Was there a failure to transmit to the plan any participant contributions	2019-09-30	Yes
Has the plan failed to provide any benefit when due under the plan	2019-09-30	No
Contributions received in cash from employer	2019-09-30	$59,027
Employer contributions (assets) at end of year	2019-09-30	$59,027
Employer contributions (assets) at beginning of year	2019-09-30	$53,780
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-09-30	$182,955
Did the plan have assets held for investment	2019-09-30	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	2019-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2019-09-30	Disclaimer
Accountancy firm name	2019-09-30	CLARK NUBER, P.S.
Accountancy firm EIN	2019-09-30	911194016
2018 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-09-30	$0
Total income from all sources (including contributions)	2018-09-30	$648,685
Total loss/gain on sale of assets	2018-09-30	$0
Total of all expenses incurred	2018-09-30	$64,826
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-09-30	$63,926
Expenses. Certain deemed distributions of participant loans	2018-09-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-09-30	$368,130
Value of total assets at end of year	2018-09-30	$3,373,904
Value of total assets at beginning of year	2018-09-30	$2,789,390
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-09-30	$900
Total interest from all sources	2018-09-30	$8,485
Total dividends received (eg from common stock, registered investment company shares)	2018-09-30	$0
Transfers to/from the plan	2018-09-30	$0
Total plan liabilities at end of year	2018-09-30	$0
Total plan liabilities at beginning of year	2018-09-30	$0
Total income from all sources	2018-09-30	$595,594
Expenses. Total of all expenses incurred	2018-09-30	$5,992
Benefits paid (including direct rollovers)	2018-09-30	$5,130
Total plan assets at end of year	2018-09-30	$2,789,390
Total plan assets at beginning of year	2018-09-30	$2,199,788
Value of fidelity bond covering the plan	2018-09-30	$1,000,000
Total contributions received or receivable from participants	2018-09-30	$240,450
Expenses. Other expenses not covered elsewhere	2018-09-30	$862
Contributions received from other sources (not participants or employers)	2018-09-30	$81,626
Other income received	2018-09-30	$273,518
Net income (gross income less expenses)	2018-09-30	$589,602
Net plan assets at end of year (total assets less liabilities)	2018-09-30	$2,789,390
Net plan assets at beginning of year (total assets less liabilities)	2018-09-30	$2,199,788
Total contributions received or receivable from employer(s)	2018-09-30	$0
Value of certain deemed distributions of participant loans	2018-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-09-30	No
Was this plan covered by a fidelity bond	2018-09-30	No
Value of fidelity bond cover	2018-09-30	$1,000,000
If this is an individual account plan, was there a blackout period	2018-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2018-09-30	No
Contributions received from participants	2018-09-30	$251,044
Income. Received or receivable in cash from other sources (including rollovers)	2018-09-30	$0
Other income not declared elsewhere	2018-09-30	$0
Administrative expenses (other) incurred	2018-09-30	$900
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-09-30	No
Value of net income/loss	2018-09-30	$583,859
Value of net assets at end of year (total assets less liabilities)	2018-09-30	$3,373,904
Value of net assets at beginning of year (total assets less liabilities)	2018-09-30	$2,789,390
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-09-30	No
Were any leases to which the plan was party in default or uncollectible	2018-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-09-30	$2,836,163
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-09-30	$2,316,500
Interest on participant loans	2018-09-30	$0
Interest earned on other investments	2018-09-30	$8,485
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-09-30	$537,741
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-09-30	$472,890
Expenses. Payments to insurance carriers foe the provision of benefits	2018-09-30	$0
Net investment gain/loss from pooled separate accounts	2018-09-30	$272,070
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-09-30	No
Was there a failure to transmit to the plan any participant contributions	2018-09-30	No
Has the plan failed to provide any benefit when due under the plan	2018-09-30	No
Contributions received in cash from employer	2018-09-30	$117,086
Employer contributions (assets) at end of year	2018-09-30	$53,780
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-09-30	$63,926
Did the plan have assets held for investment	2018-09-30	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	2018-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2018-09-30	Disclaimer
Accountancy firm name	2018-09-30	CLARK NUBER, PS
Accountancy firm EIN	2018-09-30	911194016
2017 : TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2017 401k financial data
Total income from all sources	2017-09-30	$595,594
Expenses. Total of all expenses incurred	2017-09-30	$5,992
Benefits paid (including direct rollovers)	2017-09-30	$5,130
Total plan assets at end of year	2017-09-30	$2,789,390
Total plan assets at beginning of year	2017-09-30	$2,199,788
Value of fidelity bond covering the plan	2017-09-30	$1,000,000
Total contributions received or receivable from participants	2017-09-30	$240,450
Expenses. Other expenses not covered elsewhere	2017-09-30	$862
Contributions received from other sources (not participants or employers)	2017-09-30	$81,626
Other income received	2017-09-30	$7,827
Noncash contributions received	2017-09-30	$265,691
Net income (gross income less expenses)	2017-09-30	$589,602
Net plan assets at end of year (total assets less liabilities)	2017-09-30	$2,789,390
Net plan assets at beginning of year (total assets less liabilities)	2017-09-30	$2,199,788

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON

2021: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2020: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Submission has been amended	No
2020-10-01	This submission is the final filing	No
2020-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-10-01	Plan is a collectively bargained plan	No
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2019: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	Submission has been amended	Yes
2019-10-01	This submission is the final filing	No
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – Insurance	Yes
2018: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
2018-10-01	Submission has been amended	Yes
2018-10-01	This submission is the final filing	No
2018-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-10-01	Plan is a collectively bargained plan	No
2018-10-01	Plan funding arrangement – Insurance	Yes
2018-10-01	Plan benefit arrangement – Insurance	Yes
2017: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Submission has been amended	No
2017-10-01	This submission is the final filing	No
2017-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-10-01	Plan is a collectively bargained plan	No
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2016: TAX DEFERRED ANNUITY PLAN OF GIRL SCOUTS OF WESTERN WASHINGTON 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	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

069685G

Policy instance

Insurance contract or identification number	069685G
Number of Individuals Covered	233
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $808
Are there contracts with allocated funds for individual policies?	0
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	808
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

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

Policy contract number

069685G

Policy instance

Insurance contract or identification number	069685G
Number of Individuals Covered	203
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $677
Are there contracts with allocated funds for individual policies?	0
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

069685G

Policy instance

Insurance contract or identification number	069685G
Number of Individuals Covered	202
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,274
Are there contracts with allocated funds for individual policies?	0
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	1274
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

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

Policy contract number

069685G

Policy instance

Insurance contract or identification number	069685G
Number of Individuals Covered	139
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,411
Are there contracts with allocated funds for individual policies?	0
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	1411
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

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

Policy contract number

069685G

Policy instance

Insurance contract or identification number	069685G
Number of Individuals Covered	138
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $608
Are there contracts with allocated funds for individual policies?	0
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	608
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP PROGRAM
Insurance broker organization code?	3
Insurance broker name	SEATTLE REGIONAL OFFICE

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Company Name:	GIRL SCOUTS OF WESTERN WASHINGTON
Employer identification number (EIN):	916060940
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1964-01-22
Company Identification Number:	601080755
Legal Registered Office Address:	5601 6TH AVE S STE 150 SEATTLE United States of America (USA) 981082556