401k Plan data: TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA plan

TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 401k Plan overview

Plan Name	TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA
Plan identification number	002

TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.

401k Sponsoring company profile

AMERICAN LUNG ASSOCIATION IN CALIFORNIA has sponsored the creation of one or more 401k plans.

Company Name: AMERICAN LUNG ASSOCIATION IN CALIFORNIA

Employer identification number (EIN): 940362650

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

Additional information about AMERICAN LUNG ASSOCIATION IN CALIFORNIA

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C0999971

More information about AMERICAN LUNG ASSOCIATION IN CALIFORNIA

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2019-01-01 LAURA SCOTT 2020-11-19
002 2018-01-01 LAURA SCOTT 2019-10-04 LAURA SCOTT 2019-10-04
002 2017-01-01 LAURA SCOTT 2018-07-31 LAURA SCOTT 2018-07-31
002 2016-01-01 ROCIO SAUCEDO 2017-07-18 ROCIO SAUCEDO 2017-07-18
002 2015-01-01 ROCIO SAUCEDO 2016-09-22 ROCIO SAUCEDO 2016-09-22
002 2014-01-01 DENNA OSMUNDSON 2015-07-10 DENNA OSMUNDSON 2015-07-10
002 2013-01-01 INNA ZDOROVA 2014-07-21 INNA ZDOROVA 2014-07-21
002 2012-01-01 INNA ZDOROVA 2013-07-30 INNA ZDOROVA 2013-07-30
002 2011-01-01 INNA ZDOROVA INNA ZDOROVA 2012-10-01
002 2010-01-01 INNA ZDOROVA INNA ZDOROVA 2011-10-17
002 2009-01-01 ANITA LEE
002 2009-01-01 ANITA LEE
002 2009-01-01 ANITA LEE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2019-01-01	LAURA SCOTT	2020-11-19
002	2018-01-01	LAURA SCOTT	2019-10-04	LAURA SCOTT	2019-10-04
002	2017-01-01	LAURA SCOTT	2018-07-31	LAURA SCOTT	2018-07-31
002	2016-01-01	ROCIO SAUCEDO	2017-07-18	ROCIO SAUCEDO	2017-07-18
002	2015-01-01	ROCIO SAUCEDO	2016-09-22	ROCIO SAUCEDO	2016-09-22
002	2014-01-01	DENNA OSMUNDSON	2015-07-10	DENNA OSMUNDSON	2015-07-10
002	2013-01-01	INNA ZDOROVA	2014-07-21	INNA ZDOROVA	2014-07-21
002	2012-01-01	INNA ZDOROVA	2013-07-30	INNA ZDOROVA	2013-07-30
002	2011-01-01	INNA ZDOROVA		INNA ZDOROVA	2012-10-01
002	2010-01-01	INNA ZDOROVA		INNA ZDOROVA	2011-10-17
002	2009-01-01	ANITA LEE
002	2009-01-01	ANITA LEE
002	2009-01-01	ANITA LEE

Plan Statistics for TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA

Measure Date Value
2011: TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 2011 401k membership
Total participants, beginning-of-year 2011-01-01 73
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 22
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 40
Total of all active and inactive participants 2011-01-01 62
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 63
Number of participants with account balances 2011-01-01 63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 2010 401k membership
Total participants, beginning-of-year 2010-01-01 178
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 90
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 42
Total of all active and inactive participants 2010-01-01 132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 132
Number of participants with account balances 2010-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 2009 401k membership
Total participants, beginning-of-year 2009-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 189
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 59
Total of all active and inactive participants 2009-01-01 248
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 248
Number of participants with account balances 2009-01-01 178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 2011 401k membership
Total participants, beginning-of-year	2011-01-01	73
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	22
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	40
Total of all active and inactive participants	2011-01-01	62
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	63
Number of participants with account balances	2011-01-01	63
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 2010 401k membership
Total participants, beginning-of-year	2010-01-01	178
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	90
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	42
Total of all active and inactive participants	2010-01-01	132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	132
Number of participants with account balances	2010-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 2009 401k membership
Total participants, beginning-of-year	2009-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	189
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	59
Total of all active and inactive participants	2009-01-01	248
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	248
Number of participants with account balances	2009-01-01	178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA

Measure	Date	Value
2011 : TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$78,527
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$99,562
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$98,623
Expenses. Certain deemed distributions of participant loans	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$78,934
Value of total assets at end of year	2011-12-31	$1,326,984
Value of total assets at beginning of year	2011-12-31	$1,348,019
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$939
Total interest from all sources	2011-12-31	$10,140
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$78,934
Participant contributions at end of year	2011-12-31	$3,391
Participant contributions at beginning of year	2011-12-31	$3,318
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$939
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-21,035
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,326,984
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,348,019
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$696,529
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$1,019,541
Interest on participant loans	2011-12-31	$0
Interest earned on other investments	2011-12-31	$10,140
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$627,064
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$325,160
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$0
Net investment gain/loss from pooled separate accounts	2011-12-31	$-10,547
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$98,623
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	PATEL & ASSOCIATES
Accountancy firm EIN	2011-12-31	943275707
2010 : TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$271,947
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$179,699
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$178,527
Expenses. Certain deemed distributions of participant loans	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$131,237
Value of total assets at end of year	2010-12-31	$1,348,019
Value of total assets at beginning of year	2010-12-31	$1,255,771
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,172
Total interest from all sources	2010-12-31	$10,088
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$125,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$129,350
Participant contributions at end of year	2010-12-31	$3,317
Participant contributions at beginning of year	2010-12-31	$16,213
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$1,887
Other income not declared elsewhere	2010-12-31	$13,272
Administrative expenses (other) incurred	2010-12-31	$1,172
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$92,248
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,348,019
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$1,255,771
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$1,019,542
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$886,159
Interest on participant loans	2010-12-31	$0
Interest earned on other investments	2010-12-31	$10,088
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$325,160
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$353,399
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$0
Net investment gain/loss from pooled separate accounts	2010-12-31	$117,350
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$178,527
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	PATEL AND ASSOCIATES
Accountancy firm EIN	2010-12-31	943275707

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA

2011: TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: TAX DEFERRED ANNUITY PLAN OF AMERICAN LUNG ASSOCIATION IN CALIFORNIA 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

411008A

Policy instance

Insurance contract or identification number	411008A
Number of Individuals Covered	63
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $241
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

411008A

Policy instance

Insurance contract or identification number	411008A
Number of Individuals Covered	73
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $627
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:	AMERICAN LUNG ASSOCIATION IN CALIFORNIA
Employer identification number (EIN):	940362650
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C0999971