401k Plan data: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN plan

MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 401k Plan overview

Plan Name	MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN
Plan identification number	002

MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
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

MISSION HILLS COUNTRY CLUB has sponsored the creation of one or more 401k plans.

Company Name: MISSION HILLS COUNTRY CLUB

Employer identification number (EIN): 274586359

NAIC Classification: 713900

Additional information about MISSION HILLS COUNTRY CLUB

Jurisdiction of Incorporation: Missouri Secretary of State

Incorporation Date:

Company Identification Number: B00004513

More information about MISSION HILLS COUNTRY CLUB

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01 JOYCE HESS 2023-10-10
002 2021-01-01 JOYCE HESS 2022-10-12 JOYCE HESS 2022-10-12
002 2020-01-01
002 2019-01-01 JOYCE HESS 2020-10-08 JOYCE HESS 2020-10-08
002 2018-01-01 JOYCE HESS 2019-07-30 JOYCE E HESS 2019-07-30
002 2017-01-01 JOYCE HESS 2018-07-25
002 2016-01-01 JOYCE HESS 2017-07-27
002 2015-01-01 KAREN WAGNER 2016-10-12
002 2014-01-01 KAREN WAGNER
002 2013-01-01 KAREN WAGNER KAREN WAGNER 2014-10-15
002 2012-01-01 KAREN WAGNER KAREN WAGNER 2013-10-09
002 2011-01-01 KAREN WAGNER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01	JOYCE HESS	2023-10-10
002	2021-01-01	JOYCE HESS	2022-10-12	JOYCE HESS	2022-10-12
002	2020-01-01
002	2019-01-01	JOYCE HESS	2020-10-08	JOYCE HESS	2020-10-08
002	2018-01-01	JOYCE HESS	2019-07-30	JOYCE E HESS	2019-07-30
002	2017-01-01	JOYCE HESS	2018-07-25
002	2016-01-01	JOYCE HESS	2017-07-27
002	2015-01-01	KAREN WAGNER	2016-10-12
002	2014-01-01	KAREN WAGNER
002	2013-01-01	KAREN WAGNER		KAREN WAGNER	2014-10-15
002	2012-01-01	KAREN WAGNER		KAREN WAGNER	2013-10-09
002	2011-01-01	KAREN WAGNER

Plan Statistics for MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN

401k plan membership statisitcs for MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN

Measure Date Value
2020: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 179
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 119
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 26
Total of all active and inactive participants 2020-01-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 145
Number of participants with account balances 2020-01-01 90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 1
2014: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 65
Number of retired or separated participants receiving benefits 2014-01-01 2
Number of other retired or separated participants entitled to future benefits 2014-01-01 39
Total of all active and inactive participants 2014-01-01 106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 106
Number of participants with account balances 2014-01-01 106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 2
2013: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 70
Number of retired or separated participants receiving benefits 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 34
Total of all active and inactive participants 2013-01-01 106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 106
Number of participants with account balances 2013-01-01 103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 5
2012: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 58
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 30
Total of all active and inactive participants 2012-01-01 90
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 90
Number of participants with account balances 2012-01-01 60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 8
2011: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 80
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 58
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 24
Total of all active and inactive participants 2011-01-01 82
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 82
Number of participants with account balances 2011-01-01 82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2020: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	179
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	119
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	26
Total of all active and inactive participants	2020-01-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	145
Number of participants with account balances	2020-01-01	90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	1
2014: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	65
Number of retired or separated participants receiving benefits	2014-01-01	2
Number of other retired or separated participants entitled to future benefits	2014-01-01	39
Total of all active and inactive participants	2014-01-01	106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	106
Number of participants with account balances	2014-01-01	106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	2
2013: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	70
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	34
Total of all active and inactive participants	2013-01-01	106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	106
Number of participants with account balances	2013-01-01	103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	5
2012: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	58
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	30
Total of all active and inactive participants	2012-01-01	90
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	90
Number of participants with account balances	2012-01-01	60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	8
2011: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	80
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	58
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	24
Total of all active and inactive participants	2011-01-01	82
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	82
Number of participants with account balances	2011-01-01	82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN

Measure	Date	Value
2020 : MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2020-12-31	$0
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total transfer of assets to this plan	2020-12-31	$0
Total transfer of assets from this plan	2020-12-31	$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	$871,024
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$129,060
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$126,276
Expenses. Certain deemed distributions of participant loans	2020-12-31	$0
Value of total corrective distributions	2020-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$250,885
Value of total assets at end of year	2020-12-31	$3,602,900
Value of total assets at beginning of year	2020-12-31	$2,860,936
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$2,784
Total interest from all sources	2020-12-31	$3,857
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 year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$139,531
Participant contributions at end of year	2020-12-31	$22,358
Participant contributions at beginning of year	2020-12-31	$32,254
Assets. Other investments not covered elsewhere at end of year	2020-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$0
Other income not declared elsewhere	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$741,964
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,602,900
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,860,936
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$2,784
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$3,479,240
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$2,766,216
Value of interest in pooled separate accounts at end of year	2020-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$0
Interest on participant loans	2020-12-31	$1,204
Interest earned on other investments	2020-12-31	$2,653
Value of interest in common/collective trusts at end of year	2020-12-31	$0
Value of interest in common/collective trusts at beginning of year	2020-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$101,302
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$62,466
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$0
Net investment gain/loss from pooled separate accounts	2020-12-31	$616,282
Net investment gain or loss from common/collective trusts	2020-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Assets. Invements in employer securities at end of year	2020-12-31	$0
Assets. Invements in employer securities at beginning of year	2020-12-31	$0
Contributions received in cash from employer	2020-12-31	$111,354
Income. Dividends from common stock	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$126,276
Asset. Corporate debt instrument debt (other) at end of year	2020-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2020-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2020-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2020-12-31	$0
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	HOUSE PARK DOBRATZ & WIEBLER, P.C.
Accountancy firm EIN	2020-12-31	431562209
2014 : MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$35
Total income from all sources	2014-12-31	$460,058
Expenses. Total of all expenses incurred	2014-12-31	$182,359
Benefits paid (including direct rollovers)	2014-12-31	$181,504
Total plan assets at end of year	2014-12-31	$3,232,790
Total plan assets at beginning of year	2014-12-31	$2,955,056
Value of fidelity bond covering the plan	2014-12-31	$250,000
Total contributions received or receivable from participants	2014-12-31	$182,261
Expenses. Other expenses not covered elsewhere	2014-12-31	$855
Other income received	2014-12-31	$186,448
Net income (gross income less expenses)	2014-12-31	$277,699
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$3,232,790
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$2,955,056
Assets. Value of participant loans	2014-12-31	$62,820
Total contributions received or receivable from employer(s)	2014-12-31	$91,349
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
2013 : MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$401
Total income from all sources	2013-12-31	$777,696
Expenses. Total of all expenses incurred	2013-12-31	$115,002
Benefits paid (including direct rollovers)	2013-12-31	$114,281
Total plan assets at end of year	2013-12-31	$2,955,056
Total plan assets at beginning of year	2013-12-31	$2,291,961
Value of fidelity bond covering the plan	2013-12-31	$250,000
Total contributions received or receivable from participants	2013-12-31	$154,983
Expenses. Other expenses not covered elsewhere	2013-12-31	$721
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$533,554
Net income (gross income less expenses)	2013-12-31	$662,694
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,955,056
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,291,961
Assets. Value of participant loans	2013-12-31	$67,460
Total contributions received or receivable from employer(s)	2013-12-31	$89,159
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
2012 : MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$475,538
Expenses. Total of all expenses incurred	2012-12-31	$174,501
Benefits paid (including direct rollovers)	2012-12-31	$173,458
Total plan assets at end of year	2012-12-31	$2,291,961
Total plan assets at beginning of year	2012-12-31	$1,990,924
Value of fidelity bond covering the plan	2012-12-31	$250,000
Total contributions received or receivable from participants	2012-12-31	$144,782
Expenses. Other expenses not covered elsewhere	2012-12-31	$1,043
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$241,650
Net income (gross income less expenses)	2012-12-31	$301,037
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,291,961
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,990,924
Assets. Value of participant loans	2012-12-31	$98,263
Total contributions received or receivable from employer(s)	2012-12-31	$89,106
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
2011 : MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$187,117
Expenses. Total of all expenses incurred	2011-12-31	$43,809
Benefits paid (including direct rollovers)	2011-12-31	$43,239
Total plan assets at end of year	2011-12-31	$1,990,924
Total plan assets at beginning of year	2011-12-31	$1,847,616
Value of fidelity bond covering the plan	2011-12-31	$250,000
Total contributions received or receivable from participants	2011-12-31	$139,140
Expenses. Other expenses not covered elsewhere	2011-12-31	$570
Contributions received from other sources (not participants or employers)	2011-12-31	$209
Other income received	2011-12-31	$-32,609
Net income (gross income less expenses)	2011-12-31	$143,308
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,990,924
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,847,616
Assets. Value of participant loans	2011-12-31	$90,035
Total contributions received or receivable from employer(s)	2011-12-31	$80,377
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0

Form 5500 Responses for MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN

2020: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2014: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MISSION HILLS COUNTRY CLUB 401(K) RETIREMENT PLAN 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 funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-711994

Policy instance

Insurance contract or identification number	GA-711994
Number of Individuals Covered	180
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,532
Total amount of fees paid to insurance company	USD $0
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	0
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?	Yes
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 $8,532
Insurance broker organization code?	3

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-711994

Policy instance

Insurance contract or identification number	GA-711994
Number of Individuals Covered	106
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,792
Total amount of fees paid to insurance company	USD $0
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	0
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?	Yes
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 $8,792
Insurance broker organization code?	3
Insurance broker name	UBS FINANCIAL SERVICES

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-711994

Policy instance

Insurance contract or identification number	GA-711994
Number of Individuals Covered	103
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,004
Total amount of fees paid to insurance company	USD $0
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	0
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?	Yes
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 $7,004
Insurance broker organization code?	3
Insurance broker name	UBS FINANCIAL SVCS INS AGCY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-711994

Policy instance

Insurance contract or identification number	GA-711994
Number of Individuals Covered	60
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,259
Total amount of fees paid to insurance company	USD $0
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	0
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?	Yes
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 $6,259
Insurance broker organization code?	3
Insurance broker name	UBS FINANCIAL SVCS INS AGCY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-711994

Policy instance

Insurance contract or identification number	GA-711994
Number of Individuals Covered	82
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,608
Total amount of fees paid to insurance company	USD $0
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	0
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?	Yes
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:	MISSION HILLS COUNTRY CLUB
Employer identification number (EIN):	274586359
NAIC Classification:	713900

Jurisdiction of Incorporation:	Missouri Secretary of State
Incorporation Date:
Company Identification Number:	B00004513