401k Plan data: CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN plan

CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN
Plan identification number	001

CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
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

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

Company Name: CITIZENS STATE BANK

Employer identification number (EIN): 630731481

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01 ANTHONY BURNETT 2022-07-28 ANTHONY BURNETT 2022-07-28
001 2020-01-01
001 2019-01-01 ANTHONY BURNETT 2020-07-29
001 2018-01-01 ANTHONY BURNETT 2019-07-05
001 2017-01-01 ANTHONY BURNETT 2018-06-27
001 2016-01-01 ANTHONY BURNETT 2017-07-28 ANTHONY BURNETT 2017-07-28
001 2015-01-01 ANTHONY BURNETT 2016-06-23
001 2014-01-01 ANTHONY BURNETT 2015-05-27 ANTHONY BURNETT 2015-05-27
001 2013-01-01 ANTHONY BURNETT 2014-08-12 ANTHONY BURNETT 2014-08-12
001 2012-01-01 ANTHONY BURNETT 2013-07-25
001 2011-01-01 ANTHONY BURNETT
001 2010-01-01 ANTHONY BURNETT
001 2009-01-01 ANTHONY J. BURNETT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-01-01	ANTHONY BURNETT	2022-07-28	ANTHONY BURNETT	2022-07-28
001	2020-01-01
001	2019-01-01	ANTHONY BURNETT	2020-07-29
001	2018-01-01	ANTHONY BURNETT	2019-07-05
001	2017-01-01	ANTHONY BURNETT	2018-06-27
001	2016-01-01	ANTHONY BURNETT	2017-07-28	ANTHONY BURNETT	2017-07-28
001	2015-01-01	ANTHONY BURNETT	2016-06-23
001	2014-01-01	ANTHONY BURNETT	2015-05-27	ANTHONY BURNETT	2015-05-27
001	2013-01-01	ANTHONY BURNETT	2014-08-12	ANTHONY BURNETT	2014-08-12
001	2012-01-01	ANTHONY BURNETT	2013-07-25
001	2011-01-01	ANTHONY BURNETT
001	2010-01-01	ANTHONY BURNETT
001	2009-01-01	ANTHONY J. BURNETT

Plan Statistics for CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN

Measure Date Value
2011: CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 15
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 15
Number of participants with account balances 2011-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 15
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 15
Number of participants with account balances 2010-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 15
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 0
Total of all active and inactive participants 2009-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 15
Number of participants with account balances 2009-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	15
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	15
Number of participants with account balances	2011-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	15
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	15
Number of participants with account balances	2010-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	15
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	0
Total of all active and inactive participants	2009-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	15
Number of participants with account balances	2009-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2011 : CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$35,601
Expenses. Total of all expenses incurred	2011-12-31	$10,224
Benefits paid (including direct rollovers)	2011-12-31	$10,224
Total plan assets at end of year	2011-12-31	$466,888
Total plan assets at beginning of year	2011-12-31	$441,511
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$15,225
Other income received	2011-12-31	$7,179
Net income (gross income less expenses)	2011-12-31	$25,377
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$466,888
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$441,511
Total contributions received or receivable from employer(s)	2011-12-31	$13,197
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$37,811
Total plan assets at end of year	2010-12-31	$441,511
Total plan assets at beginning of year	2010-12-31	$403,700
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$15,423
Other income received	2010-12-31	$9,161
Net income (gross income less expenses)	2010-12-31	$37,811
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$441,511
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$403,700
Total contributions received or receivable from employer(s)	2010-12-31	$13,227
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN

2011: CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: CITIZENS STATE BANK 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	CITIZENS STATE BANK
Employer identification number (EIN):	630731481
NAIC Classification:	522110
NAIC Description:	Commercial Banking