401k Plan data: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. plan

EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 401k Plan overview

Plan Name	EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC.
Plan identification number	002

EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 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.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

ADOLPH AND ROSE LEVIS JCC, INC. has sponsored the creation of one or more 401k plans.

Company Name: ADOLPH AND ROSE LEVIS JCC, INC.

Employer identification number (EIN): 651127438

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2015-01-01 AIMEE KAYE
002 2014-01-01 AIMEE KAYE AIMEE KAYE 2015-09-17
002 2013-01-01 AIMEE KAYE
002 2012-01-01 AIMEE KAYE
002 2011-01-01 AIMEE KAYE
002 2010-01-01 AIMEE KAYE 2012-04-17
002 2009-01-01 AIMEE KAYE MARTIN SCHNEER 2010-10-14
002 2009-01-01 AIMEE KAYE MARTIN SCHNEER 2010-10-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2015-01-01	AIMEE KAYE
002	2014-01-01	AIMEE KAYE		AIMEE KAYE	2015-09-17
002	2013-01-01	AIMEE KAYE
002	2012-01-01	AIMEE KAYE
002	2011-01-01	AIMEE KAYE
002	2010-01-01	AIMEE KAYE	2012-04-17
002	2009-01-01	AIMEE KAYE		MARTIN SCHNEER	2010-10-14
002	2009-01-01	AIMEE KAYE		MARTIN SCHNEER	2010-10-11

Plan Statistics for EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC.

401k plan membership statisitcs for EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC.

Measure Date Value
2015: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2015 401k membership
Total participants, beginning-of-year 2015-01-01 213
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
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 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2014 401k membership
Total participants, beginning-of-year 2014-01-01 257
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 209
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 37
Total of all active and inactive participants 2014-01-01 246
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 246
Number of participants with account balances 2014-01-01 111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2013 401k membership
Total participants, beginning-of-year 2013-01-01 229
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 225
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 31
Total of all active and inactive participants 2013-01-01 256
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 256
Number of participants with account balances 2013-01-01 116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2012 401k membership
Total participants, beginning-of-year 2012-01-01 226
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 189
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 32
Total of all active and inactive participants 2012-01-01 221
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 221
Number of participants with account balances 2012-01-01 111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 7
2011: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2011 401k membership
Total participants, beginning-of-year 2011-01-01 705
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 192
Number of retired or separated participants receiving benefits 2011-01-01 1
Number of other retired or separated participants entitled to future benefits 2011-01-01 33
Total of all active and inactive participants 2011-01-01 226
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 226
Number of participants with account balances 2011-01-01 115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 40
2009: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2009 401k membership
Total participants, beginning-of-year 2009-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 678
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 33
Total of all active and inactive participants 2009-01-01 711
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 711
Number of participants with account balances 2009-01-01 205
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 3

Measure	Date	Value
2015: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2015 401k membership
Total participants, beginning-of-year	2015-01-01	213
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
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	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2014 401k membership
Total participants, beginning-of-year	2014-01-01	257
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	209
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	37
Total of all active and inactive participants	2014-01-01	246
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	246
Number of participants with account balances	2014-01-01	111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2013 401k membership
Total participants, beginning-of-year	2013-01-01	229
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	225
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	31
Total of all active and inactive participants	2013-01-01	256
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	256
Number of participants with account balances	2013-01-01	116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2012 401k membership
Total participants, beginning-of-year	2012-01-01	226
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	189
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	32
Total of all active and inactive participants	2012-01-01	221
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	221
Number of participants with account balances	2012-01-01	111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	7
2011: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2011 401k membership
Total participants, beginning-of-year	2011-01-01	705
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	192
Number of retired or separated participants receiving benefits	2011-01-01	1
Number of other retired or separated participants entitled to future benefits	2011-01-01	33
Total of all active and inactive participants	2011-01-01	226
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	226
Number of participants with account balances	2011-01-01	115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	40
2009: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2009 401k membership
Total participants, beginning-of-year	2009-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	678
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	33
Total of all active and inactive participants	2009-01-01	711
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	711
Number of participants with account balances	2009-01-01	205
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	3

Financial Data on EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC.

Measure	Date	Value
2015 : EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets from this plan	2015-12-31	$3,568,408
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	$233,161
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$542,309
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$530,758
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$199,791
Value of total assets at end of year	2015-12-31	$0
Value of total assets at beginning of year	2015-12-31	$3,877,556
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$11,551
Total interest from all sources	2015-12-31	$23,419
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	$9,379
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$450,000
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	$119,717
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$6,634
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	$-309,148
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$3,877,556
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$0
Value of interest in pooled separate accounts at end of year	2015-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$3,061,431
Interest earned on other investments	2015-12-31	$23,419
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$816,125
Net investment gain/loss from pooled separate accounts	2015-12-31	$9,951
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	$73,440
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$530,758
Contract administrator fees	2015-12-31	$2,172
Did the plan have assets held for investment	2015-12-31	No
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	Yes
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	MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN	2015-12-31	431947695
2014 : EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 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	$471,914
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$829,810
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$824,544
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$221,196
Value of total assets at end of year	2014-12-31	$3,877,556
Value of total assets at beginning of year	2014-12-31	$4,235,452
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$5,266
Total interest from all sources	2014-12-31	$24,359
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	$4,788
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$450,000
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	$147,996
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	$-357,896
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$3,877,556
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$4,235,452
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	$3,061,431
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$3,418,643
Interest earned on other investments	2014-12-31	$24,359
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$816,125
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$816,809
Net investment gain/loss from pooled separate accounts	2014-12-31	$226,359
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	Yes
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	$73,200
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$824,544
Contract administrator fees	2014-12-31	$478
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	MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN	2014-12-31	431947695
2013 : EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$904,805
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$186,735
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$185,715
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$212,347
Value of total assets at end of year	2013-12-31	$4,235,452
Value of total assets at beginning of year	2013-12-31	$3,517,382
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$1,020
Total interest from all sources	2013-12-31	$26,174
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$450,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$145,650
Participant contributions at beginning of year	2013-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$0
Administrative expenses (other) incurred	2013-12-31	$1,020
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$718,070
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$4,235,452
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$3,517,382
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$0
Value of interest in pooled separate accounts at end of year	2013-12-31	$3,418,643
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$2,577,166
Interest earned on other investments	2013-12-31	$26,174
Value of interest in common/collective trusts at beginning of year	2013-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$816,809
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$940,216
Net investment gain/loss from pooled separate accounts	2013-12-31	$666,284
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$66,697
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$185,715
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN	2013-12-31	431947695
2012 : EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$576,692
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$372,631
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$372,071
Expenses. Certain deemed distributions of participant loans	2012-12-31	$0
Value of total corrective distributions	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$227,512
Value of total assets at end of year	2012-12-31	$3,517,382
Value of total assets at beginning of year	2012-12-31	$3,313,321
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$560
Total interest from all sources	2012-12-31	$26,822
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$0
Administrative expenses professional fees incurred	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$450,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$154,181
Participant contributions at end of year	2012-12-31	$0
Participant contributions at beginning of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$0
Other income not declared elsewhere	2012-12-31	$0
Administrative expenses (other) incurred	2012-12-31	$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	2012-12-31	No
Value of net income/loss	2012-12-31	$204,061
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$3,517,382
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$3,313,321
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Investment advisory and management fees	2012-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$0
Value of interest in pooled separate accounts at end of year	2012-12-31	$2,577,166
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$2,438,683
Interest on participant loans	2012-12-31	$0
Interest earned on other investments	2012-12-31	$26,822
Value of interest in common/collective trusts at end of year	2012-12-31	$0
Value of interest in common/collective trusts at beginning of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$940,216
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$874,638
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$0
Net investment gain/loss from pooled separate accounts	2012-12-31	$322,358
Net investment gain or loss from common/collective trusts	2012-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Assets. Invements in employer securities at end of year	2012-12-31	$0
Assets. Invements in employer securities at beginning of year	2012-12-31	$0
Contributions received in cash from employer	2012-12-31	$73,331
Income. Dividends from common stock	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$372,071
Contract administrator fees	2012-12-31	$560
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	MAYER HOFFMAN MCCANN P.C.
Accountancy firm EIN	2012-12-31	431947695
2011 : EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$251,529
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$367,249
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$366,012
Expenses. Certain deemed distributions of participant loans	2011-12-31	$0
Value of total corrective distributions	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$242,044
Value of total assets at end of year	2011-12-31	$3,313,321
Value of total assets at beginning of year	2011-12-31	$3,429,041
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,237
Total interest from all sources	2011-12-31	$24,377
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$0
Administrative expenses professional fees incurred	2011-12-31	$0
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$450,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$141,640
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$9,916
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$0
Other income not declared elsewhere	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$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	2011-12-31	No
Value of net income/loss	2011-12-31	$-115,720
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$3,313,321
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$3,429,041
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Investment advisory and management fees	2011-12-31	$0
Value of interest in pooled separate accounts at end of year	2011-12-31	$2,438,683
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$2,571,516
Interest on participant loans	2011-12-31	$0
Interest earned on other investments	2011-12-31	$24,377
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$874,638
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$857,525
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$0
Net investment gain/loss from pooled separate accounts	2011-12-31	$-14,892
Net investment gain or loss from common/collective trusts	2011-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$90,488
Income. Dividends from common stock	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$366,012
Contract administrator fees	2011-12-31	$1,237
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	MAYER HOFFMAN MCCANN, P.C.
Accountancy firm EIN	2011-12-31	431947695
2010 : EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$639,021
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$236,079
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$235,419
Expenses. Certain deemed distributions of participant loans	2010-12-31	$0
Value of total corrective distributions	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$283,180
Value of total assets at end of year	2010-12-31	$3,429,041
Value of total assets at beginning of year	2010-12-31	$3,026,099
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$660
Total interest from all sources	2010-12-31	$25,118
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$0
Administrative expenses professional fees incurred	2010-12-31	$0
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$450,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$167,623
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$3,206
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$0
Administrative expenses (other) incurred	2010-12-31	$220
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$402,942
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$3,429,041
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$3,026,099
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Investment advisory and management fees	2010-12-31	$0
Value of interest in pooled separate accounts at end of year	2010-12-31	$2,571,516
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$2,162,522
Interest on participant loans	2010-12-31	$0
Interest earned on other investments	2010-12-31	$25,118
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$857,525
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$863,577
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$0
Net investment gain/loss from pooled separate accounts	2010-12-31	$330,723
Net investment gain or loss from common/collective trusts	2010-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Assets. Invements in employer securities at end of year	2010-12-31	$0
Assets. Invements in employer securities at beginning of year	2010-12-31	$0
Contributions received in cash from employer	2010-12-31	$112,351
Income. Dividends from common stock	2010-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$235,419
Contract administrator fees	2010-12-31	$440
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	MAYER HOFFMAN MCCANN, P.C.
Accountancy firm EIN	2010-12-31	431947695
2009 : EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC.

2015: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 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	Yes
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: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 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
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 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
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 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
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 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
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: EMPLOYEE BENEFIT PLAN OF ADOLPH & ROSE LEVIS JEWISH COMMUNITY CENTER, INC. 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

RM 52089

Policy instance

Insurance contract or identification number	RM 52089
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $8,794
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 $8,794
Insurance broker organization code?	4
Insurance broker name	NATIONAL PLANNING INSURANCE AGENCY

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

RM 52089

Policy instance

Insurance contract or identification number	RM 52089
Number of Individuals Covered	111
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $10,592
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 $10,592
Insurance broker organization code?	4
Insurance broker name	NATIONAL PLANNING INSURANCE AGENCY

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 52089

Policy instance

Insurance contract or identification number	FL 52089
Number of Individuals Covered	116
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $9,679
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 $9,679
Insurance broker organization code?	4
Insurance broker name	NATIONAL PLANNING INSURANCE AGENCY

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 52089

Policy instance

Insurance contract or identification number	FL 52089
Number of Individuals Covered	221
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $9,379
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 $9,379
Insurance broker organization code?	4
Insurance broker name	NATIONAL PLANNING INSURANCE AGENCY

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

FL 52089

Policy instance

Insurance contract or identification number	FL 52089
Number of Individuals Covered	226
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,459
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:	ADOLPH AND ROSE LEVIS JCC, INC.
Employer identification number (EIN):	651127438
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations