401k Plan data: CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN plan

CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 401k Plan overview

Plan Name	CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN
Plan identification number	003

CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Stock bonus
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.
ESOP other than a leveraged ESOP - A completed Schedule E must be attached to a Form 5500 filed for an Employee Stock Ownership Plan (ESOP).
The employer maintaining this ESOP is an S Corporation
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).
Plan requiring that all or part of employer contributions be invested and held, at least for a limited period, in employer securities.

401k Sponsoring company profile

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

Company Name: CITIZENS BANK OF ADA

Employer identification number (EIN): 730756268

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2022-01-01
003 2021-01-01
003 2020-11-01

Plan Statistics for CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN

401k plan membership statisitcs for CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN

Measure Date Value
2022: CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 67
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 53
Number of retired or separated participants receiving benefits 2022-01-01 1
Number of other retired or separated participants entitled to future benefits 2022-01-01 15
Total of all active and inactive participants 2022-01-01 69
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 1
Total participants 2022-01-01 70
Number of participants with account balances 2022-01-01 70
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 8
2021: CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 57
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 55
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 8
Total of all active and inactive participants 2021-01-01 63
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 63
Number of participants with account balances 2021-01-01 49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2020 401k membership
Total participants, beginning-of-year 2020-11-01 57
Total number of active participants reported on line 7a of the Form 5500 2020-11-01 55
Number of retired or separated participants receiving benefits 2020-11-01 0
Number of other retired or separated participants entitled to future benefits 2020-11-01 0
Total of all active and inactive participants 2020-11-01 55
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-11-01 0
Total participants 2020-11-01 55
Number of participants with account balances 2020-11-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-11-01 0

Measure	Date	Value
2022: CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	67
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	53
Number of retired or separated participants receiving benefits	2022-01-01	1
Number of other retired or separated participants entitled to future benefits	2022-01-01	15
Total of all active and inactive participants	2022-01-01	69
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	1
Total participants	2022-01-01	70
Number of participants with account balances	2022-01-01	70
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	8
2021: CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	57
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	55
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	8
Total of all active and inactive participants	2021-01-01	63
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	63
Number of participants with account balances	2021-01-01	49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2020 401k membership
Total participants, beginning-of-year	2020-11-01	57
Total number of active participants reported on line 7a of the Form 5500	2020-11-01	55
Number of retired or separated participants receiving benefits	2020-11-01	0
Number of other retired or separated participants entitled to future benefits	2020-11-01	0
Total of all active and inactive participants	2020-11-01	55
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-11-01	0
Total participants	2020-11-01	55
Number of participants with account balances	2020-11-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-11-01	0

Financial Data on CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN

Measure	Date	Value
2022 : CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2022 401k financial data
Transfers to/from the plan	2022-12-31	$0
Total plan liabilities at end of year	2022-12-31	$0
Total plan liabilities at beginning of year	2022-12-31	$0
Total income from all sources	2022-12-31	$138,690
Expenses. Total of all expenses incurred	2022-12-31	$25,486
Benefits paid (including direct rollovers)	2022-12-31	$8,355
Total plan assets at end of year	2022-12-31	$1,487,637
Total plan assets at beginning of year	2022-12-31	$1,374,433
Value of fidelity bond covering the plan	2022-12-31	$1,000,000
Total contributions received or receivable from participants	2022-12-31	$90,610
Expenses. Other expenses not covered elsewhere	2022-12-31	$0
Contributions received from other sources (not participants or employers)	2022-12-31	$0
Other income received	2022-12-31	$46,330
Noncash contributions received	2022-12-31	$0
Net income (gross income less expenses)	2022-12-31	$113,204
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$1,487,637
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$1,374,433
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2022-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2022-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2022-12-31	$0
Assets. Value of employer securities	2022-12-31	$1,311,788
Total contributions received or receivable from employer(s)	2022-12-31	$1,750
Value of certain deemed distributions of participant loans	2022-12-31	$0
Value of corrective distributions	2022-12-31	$16,931
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$200
2021 : CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2021 401k financial data
Transfers to/from the plan	2021-12-31	$0
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$294,924
Expenses. Total of all expenses incurred	2021-12-31	$0
Benefits paid (including direct rollovers)	2021-12-31	$0
Total plan assets at end of year	2021-12-31	$1,374,433
Total plan assets at beginning of year	2021-12-31	$1,079,509
Value of fidelity bond covering the plan	2021-12-31	$1,000,000
Total contributions received or receivable from participants	2021-12-31	$104,726
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$159,115
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$294,924
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$1,374,433
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$1,079,509
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2021-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2021-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2021-12-31	$0
Assets. Value of employer securities	2021-12-31	$1,167,360
Total contributions received or receivable from employer(s)	2021-12-31	$31,083
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
2020 : CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2020 401k financial data
Transfers to/from the plan	2020-12-31	$942,140
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$137,369
Expenses. Total of all expenses incurred	2020-12-31	$0
Benefits paid (including direct rollovers)	2020-12-31	$0
Total plan assets at end of year	2020-12-31	$1,079,509
Total plan assets at beginning of year	2020-12-31	$0
Value of fidelity bond covering the plan	2020-12-31	$1,000,000
Total contributions received or receivable from participants	2020-12-31	$58,754
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$78,615
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$137,369
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$1,079,509
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2020-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2020-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2020-12-31	$0
Assets. Value of employer securities	2020-12-31	$969,850
Total contributions received or receivable from employer(s)	2020-12-31	$0
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0

Form 5500 Responses for CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN

2022: CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: CITIZENS BANK OF ADA 401(K) EMPLOYEE STOCK OWNERSHIP PLAN 2020 form 5500 responses
2020-11-01	Type of plan entity	Single employer plan
2020-11-01	First time form 5500 has been submitted	Yes
2020-11-01	This submission is the final filing	No
2020-11-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2020-11-01	Plan is a collectively bargained plan	No
2020-11-01	Plan funding arrangement – Insurance	Yes
2020-11-01	Plan funding arrangement – Trust	Yes
2020-11-01	Plan benefit arrangement – Insurance	Yes
2020-11-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

724885

Policy instance

Insurance contract or identification number	724885
Number of Individuals Covered	54
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

467968

Policy instance

Insurance contract or identification number	467968
Number of Individuals Covered	54
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

724885

Policy instance

Insurance contract or identification number	724885
Number of Individuals Covered	57
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

467968

Policy instance

Insurance contract or identification number	467968
Number of Individuals Covered	57
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

724885

Policy instance

Insurance contract or identification number	724885
Number of Individuals Covered	53
Insurance policy start date	2020-11-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

467968

Policy instance

Insurance contract or identification number	467968
Number of Individuals Covered	53
Insurance policy start date	2020-11-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CITIZENS BANK OF ADA
Employer identification number (EIN):	730756268
NAIC Classification:	522110
NAIC Description:	Commercial Banking