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EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 401k Plan overview

Plan NameEMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC.
Plan identification number 005

EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Money purchase (other than target benefit)
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • 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

HOSPICE OF WEST ALABAMA, INC. has sponsored the creation of one or more 401k plans.

Company Name:HOSPICE OF WEST ALABAMA, INC.
Employer identification number (EIN):630799225
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0052023-01-01MELANIE ROBERTSON2024-08-21
0052022-01-01MELANIE ROBERTSON2023-09-29
0052021-01-01
0052021-01-01MELANIE ROBERTSON2023-02-24
0052020-01-01
0052020-01-01
0052020-01-01
0052020-01-01
0052019-01-01
0052019-01-01
0052019-01-01MELANIE ROBERTSON2023-02-23
0052018-01-01MELANIE ROBERTSON
0052018-01-01
0052018-01-01
0052018-01-01MELANIE ROBERTSON2023-02-23
0052017-01-01LATRELLE PORTER2018-07-16 MELANIE ROBERTSON2018-07-16
0052016-01-01LATRELLE PORTER2017-07-19 LATRELLE PORTER2017-07-19
0052015-01-01LATRELLE PORTER2016-07-26 LATRELLE PORTER2016-07-26
0052014-01-01LATRELLE PORTER2015-07-20 LATRELLE PORTER2015-07-20
0052013-01-01LATRELLE BELL2014-07-24 LATRELLE BELL2014-07-24
0052012-01-01LATRELLE BELL2013-07-25 LATRELLE BELL2013-07-25
0052011-01-01LATRELLE BELL2012-07-20 LATRELLE BELL2012-07-20
0052010-01-01LATRELLE BELL2011-05-24 LATRELLE BELL2011-05-24

Plan Statistics for EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC.

401k plan membership statisitcs for EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC.

Measure Date Value
2021: EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2021 401k membership
Total participants, beginning-of-year2021-01-01103
Total number of active participants reported on line 7a of the Form 55002021-01-0163
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0125
Total of all active and inactive participants2021-01-0188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-012
Total participants2021-01-0190
Number of participants with account balances2021-01-0189
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-017
2020: EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2020 401k membership
Total participants, beginning-of-year2020-01-01104
Total number of active participants reported on line 7a of the Form 55002020-01-0174
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0128
Total of all active and inactive participants2020-01-01102
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-011
Total participants2020-01-01103
Number of participants with account balances2020-01-0196
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-012
2019: EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2019 401k membership
Total participants, beginning-of-year2019-01-01105
Total number of active participants reported on line 7a of the Form 55002019-01-0173
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0130
Total of all active and inactive participants2019-01-01103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-011
Total participants2019-01-01104
Number of participants with account balances2019-01-0198
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-012
2018: EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2018 401k membership
Total participants, beginning-of-year2018-01-01106
Total number of active participants reported on line 7a of the Form 55002018-01-0182
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0123
Total of all active and inactive participants2018-01-01105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01105
Number of participants with account balances2018-01-01100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-011

Financial Data on EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC.

Measure Date Value
2021 : EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$737,735
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$416,779
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$416,007
Expenses. Certain deemed distributions of participant loans2021-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$308,273
Value of total assets at end of year2021-12-31$3,761,532
Value of total assets at beginning of year2021-12-31$3,440,576
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$772
Total interest from all sources2021-12-31$4,159
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31No
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$197,114
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$33,401
Other income not declared elsewhere2021-12-31$0
Administrative expenses (other) incurred2021-12-31$772
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$320,956
Value of net assets at end of year (total assets less liabilities)2021-12-31$3,761,532
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$3,440,576
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$3,353,049
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$3,014,868
Interest on participant loans2021-12-31$0
Interest earned on other investments2021-12-31$4,159
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$408,483
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$425,708
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$0
Net investment gain/loss from pooled separate accounts2021-12-31$425,303
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$77,758
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$416,007
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Disclaimer
Accountancy firm name2021-12-31LAWRENCE, HITT & PUGH, LLP
Accountancy firm EIN2021-12-31631179823
2020 : EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$674,715
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$579,003
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$578,166
Expenses. Certain deemed distributions of participant loans2020-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$229,125
Value of total assets at end of year2020-12-31$3,440,576
Value of total assets at beginning of year2020-12-31$3,344,864
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$837
Total interest from all sources2020-12-31$4,853
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31No
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$162,556
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$0
Other income not declared elsewhere2020-12-31$0
Administrative expenses (other) incurred2020-12-31$837
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$95,712
Value of net assets at end of year (total assets less liabilities)2020-12-31$3,440,576
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$3,344,864
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$3,014,868
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$2,789,452
Interest on participant loans2020-12-31$0
Interest earned on other investments2020-12-31$4,853
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$425,708
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$555,412
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$0
Net investment gain/loss from pooled separate accounts2020-12-31$440,737
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$66,569
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$578,166
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31LAWRENCE, HITT & PUGH, LLP
Accountancy firm EIN2020-12-31631179823
2019 : EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$815,401
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$558,237
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$557,289
Expenses. Certain deemed distributions of participant loans2019-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$270,234
Value of total assets at end of year2019-12-31$3,344,864
Value of total assets at beginning of year2019-12-31$3,087,700
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$948
Total interest from all sources2019-12-31$11,040
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$400,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$183,311
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$260
Other income not declared elsewhere2019-12-31$0
Administrative expenses (other) incurred2019-12-31$948
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$257,164
Value of net assets at end of year (total assets less liabilities)2019-12-31$3,344,864
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$3,087,700
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$2,789,452
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$2,445,472
Interest on participant loans2019-12-31$0
Interest earned on other investments2019-12-31$11,040
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$555,412
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$642,228
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Net investment gain/loss from pooled separate accounts2019-12-31$534,127
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$86,663
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$557,289
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31LAWRENCE, HITT & PUGH, LLP
Accountancy firm EIN2019-12-31631179823
2018 : EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$170,488
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$187,644
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$186,622
Expenses. Certain deemed distributions of participant loans2018-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$362,573
Value of total assets at end of year2018-12-31$3,087,700
Value of total assets at beginning of year2018-12-31$3,104,856
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$1,022
Total interest from all sources2018-12-31$5,668
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$210,632
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$157,082
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$123,806
Other income not declared elsewhere2018-12-31$0
Administrative expenses (other) incurred2018-12-31$1,022
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-17,156
Value of net assets at end of year (total assets less liabilities)2018-12-31$3,087,700
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$3,104,856
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$2,445,472
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$2,663,642
Interest on participant loans2018-12-31$0
Interest earned on other investments2018-12-31$5,668
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$642,228
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$441,214
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$0
Net investment gain/loss from pooled separate accounts2018-12-31$-197,753
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$81,685
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$186,622
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31LAWRENCE, HITT & PUGH, LLP.
Accountancy firm EIN2018-12-31631179823

Form 5500 Responses for EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC.

2021: EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: EMPLOYEE BENEFIT PLAN OF HOSPICE OF WEST ALABAMA, INC. 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedYes
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number013652I
Policy instance 1
Insurance contract or identification number013652I
Number of Individuals Covered90
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $292
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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $0
Amount paid for insurance broker fees292
Additional information about fees paid to insurance brokerPORTION 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 number013652I
Policy instance 1
Insurance contract or identification number013652I
Number of Individuals Covered103
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $292
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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $0
Amount paid for insurance broker fees292
Additional information about fees paid to insurance brokerPORTION 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 number013652I
Policy instance 1
Insurance contract or identification number013652I
Number of Individuals Covered104
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,412
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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $0
Amount paid for insurance broker fees1412
Additional information about fees paid to insurance brokerPORTION 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 number013652I
Policy instance 1
Insurance contract or identification number013652I
Number of Individuals Covered105
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $424
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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $0
Amount paid for insurance broker fees424
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3

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