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EMPLOYEE BENEFIT PLAN OF FAMILY SERVICE MADISON, INC. 401k Plan overview

Plan NameEMPLOYEE BENEFIT PLAN OF FAMILY SERVICE MADISON, INC.
Plan identification number 004

EMPLOYEE BENEFIT PLAN OF FAMILY SERVICE MADISON, INC. 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.
  • Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

FAMILY SERVICE MADISON, INC. has sponsored the creation of one or more 401k plans.

Company Name:FAMILY SERVICE MADISON, INC.
Employer identification number (EIN):390806186
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT PLAN OF FAMILY SERVICE MADISON, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0042022-01-01KATHY SCHOFF2023-10-10
0042021-01-01
0042021-01-01KATHY SCHOFF2022-10-10
0042020-01-01KATHY SCHOFF2021-07-26
0042019-01-01KATHY SCHOFF2020-08-24
0042018-01-01DAVID JOHNSON2019-07-23
0042017-01-01DAVID JOHNSON2018-03-30 DAVID JOHNSON2018-03-30
0042016-01-01DAVE JOHNSON2017-07-18 DAVE JOHNSON2017-07-18
0042015-01-01RUSSELL KING2016-07-26 RUSSELL KING2016-07-26
0042014-01-01RUSSELL KING2015-06-09 RUSSELL KING2015-06-09
0042013-01-01DAVID JOHNSON2014-08-29 DAVID JOHNSON2014-08-29
0042012-01-01DAVID JOHNSON2013-08-27 DAVID JOHNSON2013-08-27
0042011-01-01DAVID JOHNSON2012-05-16 DAVID JOHNSON2012-05-16
0042010-01-01DAVID JOHNSON2011-06-28 DAVID JOHNSON2011-06-28

Plan Statistics for EMPLOYEE BENEFIT PLAN OF FAMILY SERVICE MADISON, INC.

401k plan membership statisitcs for EMPLOYEE BENEFIT PLAN OF FAMILY SERVICE MADISON, INC.

Measure Date Value
2021: EMPLOYEE BENEFIT PLAN OF FAMILY SERVICE MADISON, INC. 2021 401k membership
Total participants, beginning-of-year2021-01-01101
Total number of active participants reported on line 7a of the Form 55002021-01-0141
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0163
Total of all active and inactive participants2021-01-01104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-011
Total participants2021-01-01105
Number of participants with account balances2021-01-01103
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-015

Financial Data on EMPLOYEE BENEFIT PLAN OF FAMILY SERVICE MADISON, INC.

Measure Date Value
2021 : EMPLOYEE BENEFIT PLAN OF FAMILY SERVICE MADISON, INC. 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$605,003
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$171,735
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$166,736
Expenses. Certain deemed distributions of participant loans2021-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$112,311
Value of total assets at end of year2021-12-31$3,427,316
Value of total assets at beginning of year2021-12-31$2,994,048
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$4,999
Total interest from all sources2021-12-31$2,257
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31No
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$109,847
Participant contributions at end of year2021-12-31$17,356
Participant contributions at beginning of year2021-12-31$29,124
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$2,818
Other income not declared elsewhere2021-12-31$352
Administrative expenses (other) incurred2021-12-31$4,999
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$433,268
Value of net assets at end of year (total assets less liabilities)2021-12-31$3,427,316
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$2,994,048
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$3,310,098
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$2,869,794
Interest on participant loans2021-12-31$1,295
Interest earned on other investments2021-12-31$962
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$99,862
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$95,130
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$0
Net investment gain/loss from pooled separate accounts2021-12-31$490,083
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$-354
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$166,736
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

Form 5500 Responses for EMPLOYEE BENEFIT PLAN OF FAMILY SERVICE MADISON, INC.

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

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050935H
Policy instance 1
Insurance contract or identification number050935H
Number of Individuals Covered105
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $235
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees235
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3

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