401k Plan data: POLISH AMERICAN ASSOCIATION 401(K) PLAN plan

POLISH AMERICAN ASSOCIATION 401(K) PLAN 401k Plan overview

Plan Name	POLISH AMERICAN ASSOCIATION 401(K) PLAN
Plan identification number	001

POLISH AMERICAN ASSOCIATION 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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

POLISH AMERICAN ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name: POLISH AMERICAN ASSOCIATION

Employer identification number (EIN): 362240816

NAIC Classification: 812990
NAIC Description: All Other Personal Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan POLISH AMERICAN ASSOCIATION 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01 SONJI JONES 2021-10-05
001 2019-01-01 SONJI JONES 2020-10-14
001 2018-01-01 SONJI JONES 2019-10-01
001 2017-01-01 SONJI JONES 2018-10-11
001 2016-01-01 SONJI JONES
001 2015-01-01 SONJI JONES
001 2015-01-01 SONJI JONES
001 2014-01-01
001 2013-01-01 PATRICK MADIGAN 2014-10-01
001 2012-01-01 PATRICK MADIGAN 2013-10-15
001 2011-01-01 PATRICK MADIGAN 2012-07-25
001 2010-01-01 PATRICK MADIGAN 2011-10-18

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01	SONJI JONES	2021-10-05
001	2019-01-01	SONJI JONES	2020-10-14
001	2018-01-01	SONJI JONES	2019-10-01
001	2017-01-01	SONJI JONES	2018-10-11
001	2016-01-01	SONJI JONES
001	2015-01-01	SONJI JONES
001	2015-01-01	SONJI JONES
001	2014-01-01
001	2013-01-01	PATRICK MADIGAN	2014-10-01
001	2012-01-01	PATRICK MADIGAN	2013-10-15
001	2011-01-01	PATRICK MADIGAN	2012-07-25
001	2010-01-01	PATRICK MADIGAN	2011-10-18

Plan Statistics for POLISH AMERICAN ASSOCIATION 401(K) PLAN

401k plan membership statisitcs for POLISH AMERICAN ASSOCIATION 401(K) PLAN

Measure Date Value
2016: POLISH AMERICAN ASSOCIATION 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 77
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 19
Total of all active and inactive participants 2016-01-01 96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 96
Number of participants with account balances 2016-01-01 58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 2
2015: POLISH AMERICAN ASSOCIATION 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 115
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 21
Total of all active and inactive participants 2015-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 136
Number of participants with account balances 2015-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 1
2014: POLISH AMERICAN ASSOCIATION 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 120
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 14
Total of all active and inactive participants 2014-01-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 134
Number of participants with account balances 2014-01-01 72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1

Measure	Date	Value
2016: POLISH AMERICAN ASSOCIATION 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	77
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	19
Total of all active and inactive participants	2016-01-01	96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	96
Number of participants with account balances	2016-01-01	58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2
2015: POLISH AMERICAN ASSOCIATION 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	115
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	21
Total of all active and inactive participants	2015-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	136
Number of participants with account balances	2015-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	1
2014: POLISH AMERICAN ASSOCIATION 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	120
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	14
Total of all active and inactive participants	2014-01-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	134
Number of participants with account balances	2014-01-01	72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1

Financial Data on POLISH AMERICAN ASSOCIATION 401(K) PLAN

Measure	Date	Value
2016 : POLISH AMERICAN ASSOCIATION 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$106,879
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$79,807
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$74,992
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$45,754
Value of total assets at end of year	2016-12-31	$931,894
Value of total assets at beginning of year	2016-12-31	$904,822
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$4,815
Total interest from all sources	2016-12-31	$1,023
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$130
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$100,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$42,025
Participant contributions at end of year	2016-12-31	$13,358
Participant contributions at beginning of year	2016-12-31	$35,680
Participant contributions at beginning of year	2016-12-31	$72
Total non interest bearing cash at end of year	2016-12-31	$842
Total non interest bearing cash at beginning of year	2016-12-31	$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	2016-12-31	No
Value of net income/loss	2016-12-31	$27,072
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$931,894
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$904,822
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Investment advisory and management fees	2016-12-31	$4,543
Value of interest in pooled separate accounts at end of year	2016-12-31	$917,694
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$869,035
Interest on participant loans	2016-12-31	$1,023
Net investment gain/loss from pooled separate accounts	2016-12-31	$60,102
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$3,729
Employer contributions (assets) at beginning of year	2016-12-31	$35
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$74,992
Contract administrator fees	2016-12-31	$142
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	CUKIERSKI & COCHRANE, LLC
Accountancy firm EIN	2016-12-31	364239322
2015 : POLISH AMERICAN ASSOCIATION 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$75,695
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$96,386
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$94,871
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$86,938
Value of total assets at end of year	2015-12-31	$904,822
Value of total assets at beginning of year	2015-12-31	$925,513
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$1,515
Total interest from all sources	2015-12-31	$1,916
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$215
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$100,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$63,825
Participant contributions at end of year	2015-12-31	$35,680
Participant contributions at beginning of year	2015-12-31	$37,559
Participant contributions at end of year	2015-12-31	$72
Total non interest bearing cash at end of year	2015-12-31	$0
Total non interest bearing cash at beginning of year	2015-12-31	$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	2015-12-31	No
Value of net income/loss	2015-12-31	$-20,691
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$904,822
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$925,513
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Investment advisory and management fees	2015-12-31	$1,124
Value of interest in pooled separate accounts at end of year	2015-12-31	$869,035
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$887,954
Interest on participant loans	2015-12-31	$1,916
Net investment gain/loss from pooled separate accounts	2015-12-31	$-13,159
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$23,113
Employer contributions (assets) at end of year	2015-12-31	$35
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$94,871
Contract administrator fees	2015-12-31	$176
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	CUKIERSKI & KOWAL LLC
Accountancy firm EIN	2015-12-31	364239322
2014 : POLISH AMERICAN ASSOCIATION 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$142,603
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$26,337
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$25,998
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$99,487
Value of total assets at end of year	2014-12-31	$925,514
Value of total assets at beginning of year	2014-12-31	$809,248
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$339
Total interest from all sources	2014-12-31	$1,948
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$204
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$100,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$77,593
Participant contributions at end of year	2014-12-31	$37,559
Participant contributions at beginning of year	2014-12-31	$44,173
Total non interest bearing cash at end of year	2014-12-31	$0
Total non interest bearing cash at beginning of year	2014-12-31	$1,262
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$116,266
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$925,514
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$809,248
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$887,955
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$763,813
Interest on participant loans	2014-12-31	$1,948
Net investment gain/loss from pooled separate accounts	2014-12-31	$41,168
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$21,894
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$25,998
Contract administrator fees	2014-12-31	$135
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	CUKIERSKI & KOWAL LLC
Accountancy firm EIN	2014-12-31	364239322

Form 5500 Responses for POLISH AMERICAN ASSOCIATION 401(K) PLAN

2016: POLISH AMERICAN ASSOCIATION 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: POLISH AMERICAN ASSOCIATION 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: POLISH AMERICAN ASSOCIATION 401(K) 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 - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

110990

Policy instance

Insurance contract or identification number	110990
Number of Individuals Covered	73
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,339
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?	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
Amount paid for insurance broker fees	1124
Additional information about fees paid to insurance broker	REGSITERED INVESTMENT ADVISOR FEES
Insurance broker organization code?	7
Insurance broker name	CALIFORNIA PENSION ADMINISTRATORS

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

110990

Policy instance

Insurance contract or identification number	110990
Number of Individuals Covered	76
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $135
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?	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
Amount paid for insurance broker fees	135
Additional information about fees paid to insurance broker	TRANSACTION FEES
Insurance broker organization code?	5
Insurance broker name	CALIFORNIA PENSION ADMINISTRATORS

Potentially related plans

POLISH AMERICAN FEDERAL CREDIT 401(K) PROFIT SHARING PLAN & TRUST [EIN = 382116791]

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Company Name:	POLISH AMERICAN ASSOCIATION
Employer identification number (EIN):	362240816
NAIC Classification:	812990
NAIC Description:	All Other Personal Services