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COMMUNITY STATE BANK 401(K) PLAN 401k Plan overview

Plan NameCOMMUNITY STATE BANK 401(K) PLAN
Plan identification number 002

COMMUNITY STATE BANK 401(K) PLAN Benefits

401k Plan TypeDefined 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.
  • 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.
  • Life insurance

401k Sponsoring company profile

COMMUNITY STATE BANK has sponsored the creation of one or more 401k plans.

Company Name:COMMUNITY STATE BANK
Employer identification number (EIN):231354306
NAIC Classification:522110
NAIC Description:Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY STATE BANK 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01
0022021-01-01
0022020-01-01
0022019-01-01
0022018-01-01
0022017-01-01MICHELE I. PRICE
0022016-01-01
0022015-01-01
0022014-01-01DENISE LOCKE2015-07-28
0022013-01-01DENISE LOCKE2014-09-25
0022012-01-01DENISE LOCKE2013-10-15
0022011-01-01TRUDY K. EVERHART2012-04-26
0022010-01-01TRUDY K. EVERHART2011-06-16

Plan Statistics for COMMUNITY STATE BANK 401(K) PLAN

401k plan membership statisitcs for COMMUNITY STATE BANK 401(K) PLAN

Measure Date Value
2022: COMMUNITY STATE BANK 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01121
Total number of active participants reported on line 7a of the Form 55002022-01-01102
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0116
Total of all active and inactive participants2022-01-01118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-011
Total participants2022-01-01119
Number of participants with account balances2022-01-01116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: COMMUNITY STATE BANK 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01123
Total number of active participants reported on line 7a of the Form 55002021-01-01107
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0113
Total of all active and inactive participants2021-01-01120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01120
Number of participants with account balances2021-01-01118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: COMMUNITY STATE BANK 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01114
Total number of active participants reported on line 7a of the Form 55002020-01-01110
Number of retired or separated participants receiving benefits2020-01-019
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01119
Number of participants with account balances2020-01-01117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: COMMUNITY STATE BANK 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01105
Total number of active participants reported on line 7a of the Form 55002019-01-01102
Number of retired or separated participants receiving benefits2019-01-0112
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01114
Number of participants with account balances2019-01-01111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: COMMUNITY STATE BANK 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01118
Total number of active participants reported on line 7a of the Form 55002018-01-0198
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-017
Total of all active and inactive participants2018-01-01105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01105
Number of participants with account balances2018-01-01105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: COMMUNITY STATE BANK 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01118
Total number of active participants reported on line 7a of the Form 55002017-01-01109
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-019
Total of all active and inactive participants2017-01-01118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01118
Number of participants with account balances2017-01-01117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: COMMUNITY STATE BANK 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01121
Total number of active participants reported on line 7a of the Form 55002016-01-01112
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-016
Total of all active and inactive participants2016-01-01118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01118
Number of participants with account balances2016-01-01115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010

Financial Data on COMMUNITY STATE BANK 401(K) PLAN

Measure Date Value
2022 : COMMUNITY STATE BANK 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-164,728
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$502,881
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$465,834
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$661,493
Value of total assets at end of year2022-12-31$4,796,220
Value of total assets at beginning of year2022-12-31$5,463,829
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$37,047
Total interest from all sources2022-12-31$4,223
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$105,302
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$105,302
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$357,866
Participant contributions at end of year2022-12-31$73,278
Participant contributions at beginning of year2022-12-31$87,600
Assets. Other investments not covered elsewhere at end of year2022-12-31$56,051
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$53,855
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$157,959
Other income not declared elsewhere2022-12-31$2,195
Administrative expenses (other) incurred2022-12-31$420
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-667,609
Value of net assets at end of year (total assets less liabilities)2022-12-31$4,796,220
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$5,463,829
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$24,290
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$4,397,036
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$5,220,114
Interest on participant loans2022-12-31$4,045
Interest earned on other investments2022-12-31$178
Value of interest in common/collective trusts at end of year2022-12-31$269,855
Value of interest in common/collective trusts at beginning of year2022-12-31$102,260
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$480
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-942,141
Net investment gain or loss from common/collective trusts2022-12-31$4,200
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$145,668
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$465,354
Contract administrator fees2022-12-31$12,337
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31S.R. SNODGRASS, P.C.
Accountancy firm EIN2022-12-31251616561
2021 : COMMUNITY STATE BANK 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$1,170,953
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$794,609
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$747,895
Value of total corrective distributions2021-12-31$127
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$548,582
Value of total assets at end of year2021-12-31$5,463,829
Value of total assets at beginning of year2021-12-31$5,087,485
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$46,587
Total interest from all sources2021-12-31$5,500
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$317,201
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$317,201
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$355,838
Participant contributions at end of year2021-12-31$87,600
Participant contributions at beginning of year2021-12-31$101,319
Assets. Other investments not covered elsewhere at end of year2021-12-31$53,855
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$49,979
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$56,214
Other income not declared elsewhere2021-12-31$3,877
Administrative expenses (other) incurred2021-12-31$13,511
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$376,344
Value of net assets at end of year (total assets less liabilities)2021-12-31$5,463,829
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$5,087,485
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$23,106
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$5,220,114
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$4,837,208
Interest on participant loans2021-12-31$5,500
Value of interest in common/collective trusts at end of year2021-12-31$102,260
Value of interest in common/collective trusts at beginning of year2021-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$98,979
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$2,200
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$294,677
Net investment gain or loss from common/collective trusts2021-12-31$1,116
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$136,530
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$745,695
Contract administrator fees2021-12-31$9,970
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31Yes
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Disclaimer
Accountancy firm name2021-12-31S.R. SNODGRASS, P.C.
Accountancy firm EIN2021-12-31251616561
2020 : COMMUNITY STATE BANK 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$1,087,668
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$386,256
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$326,040
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$471,776
Value of total assets at end of year2020-12-31$5,087,485
Value of total assets at beginning of year2020-12-31$4,386,073
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$60,216
Total interest from all sources2020-12-31$615,892
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$341,731
Participant contributions at end of year2020-12-31$101,319
Participant contributions at beginning of year2020-12-31$108,828
Assets. Other investments not covered elsewhere at end of year2020-12-31$49,979
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$47,142
Administrative expenses (other) incurred2020-12-31$60,216
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$701,412
Value of net assets at end of year (total assets less liabilities)2020-12-31$5,087,485
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$4,386,073
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$4,837,208
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$4,101,376
Interest on participant loans2020-12-31$5,497
Interest earned on other investments2020-12-31$610,395
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$98,979
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$128,727
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$130,045
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$326,040
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31S.R. SNODGRASS, P.C.
Accountancy firm EIN2020-12-31251616561
2019 : COMMUNITY STATE BANK 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$1,166,918
Total income from all sources (including contributions)2019-12-31$1,166,918
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$351,364
Total of all expenses incurred2019-12-31$351,364
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$300,833
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$300,833
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$413,547
Value of total assets at end of year2019-12-31$4,386,073
Value of total assets at end of year2019-12-31$4,386,073
Value of total assets at beginning of year2019-12-31$3,570,519
Value of total assets at beginning of year2019-12-31$3,570,519
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$50,531
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$50,531
Total interest from all sources2019-12-31$753,371
Total interest from all sources2019-12-31$753,371
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$292,734
Contributions received from participants2019-12-31$292,734
Participant contributions at end of year2019-12-31$108,828
Participant contributions at end of year2019-12-31$108,828
Participant contributions at beginning of year2019-12-31$79,958
Participant contributions at beginning of year2019-12-31$79,958
Assets. Other investments not covered elsewhere at end of year2019-12-31$47,142
Assets. Other investments not covered elsewhere at end of year2019-12-31$47,142
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$44,333
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$44,333
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$5,077
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$5,077
Administrative expenses (other) incurred2019-12-31$50,531
Administrative expenses (other) incurred2019-12-31$50,531
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$815,554
Value of net income/loss2019-12-31$815,554
Value of net assets at end of year (total assets less liabilities)2019-12-31$4,386,073
Value of net assets at end of year (total assets less liabilities)2019-12-31$4,386,073
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$3,570,519
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$4,101,376
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$4,101,376
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$3,365,769
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$3,365,769
Interest on participant loans2019-12-31$5,489
Interest on participant loans2019-12-31$5,489
Interest earned on other investments2019-12-31$747,882
Interest earned on other investments2019-12-31$747,882
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$128,727
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$128,727
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$80,459
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$80,459
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$1,329
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$1,329
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$115,736
Contributions received in cash from employer2019-12-31$115,736
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$299,504
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$299,504
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31S.R. SNODGRASS, P.C.
Accountancy firm name2019-12-31S.R. SNODGRASS, P.C.
Accountancy firm EIN2019-12-31251616561
Accountancy firm EIN2019-12-31251616561
2018 : COMMUNITY STATE BANK 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$75,813
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$338,399
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$297,296
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$371,905
Value of total assets at end of year2018-12-31$3,570,519
Value of total assets at beginning of year2018-12-31$3,833,105
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$41,103
Total interest from all sources2018-12-31$-296,092
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$260,884
Participant contributions at end of year2018-12-31$79,958
Participant contributions at beginning of year2018-12-31$63,395
Assets. Other investments not covered elsewhere at end of year2018-12-31$44,333
Assets. Other investments not covered elsewhere at beginning of year2018-12-31$48,632
Administrative expenses (other) incurred2018-12-31$41,103
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-262,586
Value of net assets at end of year (total assets less liabilities)2018-12-31$3,570,519
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$3,833,105
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$3,365,769
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$3,663,952
Interest on participant loans2018-12-31$3,558
Interest earned on other investments2018-12-31$-299,650
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$80,459
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$57,126
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$1,471
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$111,021
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$295,825
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31SMITH ELLIOTT KEARNS & CO LLC
Accountancy firm EIN2018-12-31520783935
2017 : COMMUNITY STATE BANK 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$846,811
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$168,277
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$127,799
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$342,923
Value of total assets at end of year2017-12-31$3,833,105
Value of total assets at beginning of year2017-12-31$3,154,571
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$40,478
Total interest from all sources2017-12-31$4,059
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$233,484
Participant contributions at end of year2017-12-31$63,395
Participant contributions at beginning of year2017-12-31$86,279
Assets. Other investments not covered elsewhere at end of year2017-12-31$48,632
Assets. Other investments not covered elsewhere at beginning of year2017-12-31$71,978
Administrative expenses (other) incurred2017-12-31$40,478
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$678,534
Value of net assets at end of year (total assets less liabilities)2017-12-31$3,833,105
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$3,154,571
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$3,663,952
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$2,967,935
Interest on participant loans2017-12-31$3,419
Interest earned on other investments2017-12-31$640
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$57,126
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$28,379
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$2,112
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$499,829
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$109,439
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$125,687
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31Yes
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31SMITH ELLIOTT KEARNS & CO LLC
Accountancy firm EIN2017-12-31520783935
2016 : COMMUNITY STATE BANK 401(K) PLAN 2016 401k financial data
Total income from all sources (including contributions)2016-12-31$501,776
Total of all expenses incurred2016-12-31$635,988
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$614,830
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$316,517
Value of total assets at end of year2016-12-31$3,154,571
Value of total assets at beginning of year2016-12-31$3,288,783
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$21,158
Total interest from all sources2016-12-31$4,123
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$88,440
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$88,440
Administrative expenses professional fees incurred2016-12-31$21,158
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$210,464
Participant contributions at end of year2016-12-31$86,279
Participant contributions at beginning of year2016-12-31$86,046
Assets. Other investments not covered elsewhere at end of year2016-12-31$71,978
Assets. Other investments not covered elsewhere at beginning of year2016-12-31$77,743
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$0
Other income not declared elsewhere2016-12-31$5,514
Administrative expenses (other) incurred2016-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-134,212
Value of net assets at end of year (total assets less liabilities)2016-12-31$3,154,571
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$3,288,783
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$2,967,935
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$2,964,589
Interest on participant loans2016-12-31$4,123
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$28,379
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$160,405
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$87,182
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$106,053
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$614,830
Contract administrator fees2016-12-31$0
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31S. R. SNODGRASS, P.C.
Accountancy firm EIN2016-12-31251616561

Form 5500 Responses for COMMUNITY STATE BANK 401(K) PLAN

2022: COMMUNITY STATE BANK 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: COMMUNITY STATE BANK 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: COMMUNITY STATE BANK 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: COMMUNITY STATE BANK 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: COMMUNITY STATE BANK 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: COMMUNITY STATE BANK 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: COMMUNITY STATE BANK 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberAPM-208590
Policy instance 1
Insurance contract or identification numberAPM-208590
Number of Individuals Covered5
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $13
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberMR 62505-1
Policy instance 1
Insurance contract or identification numberMR 62505-1
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-03-01
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberAPM-208590
Policy instance 2
Insurance contract or identification numberAPM-208590
Number of Individuals Covered5
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $13
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberMR 62505-1
Policy instance 1
Insurance contract or identification numberMR 62505-1
Number of Individuals Covered111
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?1
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberMR 62505-1
Policy instance 1
Insurance contract or identification numberMR 62505-1
Number of Individuals Covered111
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?1
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberMR 62505-1
Policy instance 1
Insurance contract or identification numberMR 62505-1
Number of Individuals Covered102
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?1
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberMR 62505-1
Policy instance 1
Insurance contract or identification numberMR 62505-1
Number of Individuals Covered115
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?1
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameJON ALAN HENDERSON
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number373308-01
Policy instance 2
Insurance contract or identification number373308-01
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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