401k Plan data: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN plan

COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 401k Plan overview

Plan Name	COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN
Plan identification number	506

COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Other welfare benefit cover

401k Sponsoring company profile

COMMUNITY BANCSHARES, INC. has sponsored the creation of one or more 401k plans.

Company Name: COMMUNITY BANCSHARES, INC.

Employer identification number (EIN): 311002504

NAIC Classification: 522110
NAIC Description: Commercial Banking

Additional information about COMMUNITY BANCSHARES, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 1999-05-27

Company Identification Number: 69320282

Legal Registered Office Address: 601 SW 2ND AVE STE 2100

PORTLAND
United States of America (USA)
97204

More information about COMMUNITY BANCSHARES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2022-01-01 J. BEN CROW 2023-07-20
506 2021-01-01
506 2020-01-01
506 2019-01-01
506 2018-01-01
506 2017-01-01 BEN CROW

Plan Statistics for COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN

401k plan membership statisitcs for COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN

Measure Date Value
2022: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 221
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 178
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 178
2021: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 152
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 0
Total of all active and inactive participants 2021-01-01 152
2020: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 168
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 169
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 169
2019: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 169
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 168
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 168
2018: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 146
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 146
2017: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 122
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 122

Measure	Date	Value
2022: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	221
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	178
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	178
2021: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	152
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	0
Total of all active and inactive participants	2021-01-01	152
2020: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	168
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	169
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	169
2019: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	169
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	168
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	168
2018: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	146
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	146
2017: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	122
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	122

Form 5500 Responses for COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN

2022: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
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 – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
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 – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: COMMUNITY BANCSHARES, INC. MEDICAL AND DENTAL PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

US FIRE (National Association of Insurance Commissioners NAIC id number: 21113 )

Policy contract number

US59868217

Policy instance

Insurance contract or identification number	US59868217
Number of Individuals Covered	122
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	SPECIFIC AND AGGREGATE EXCESS LOSS INDEMNITY
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $319,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	COMMUNITY BANCSHARES, INC.
Employer identification number (EIN):	311002504
NAIC Classification:	522110
NAIC Description:	Commercial Banking

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	1999-05-27
Company Identification Number:	69320282
Legal Registered Office Address:	601 SW 2ND AVE STE 2100 PORTLAND United States of America (USA) 97204

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
506	2022-01-01	J. BEN CROW	2023-07-20
506	2021-01-01
506	2020-01-01
506	2019-01-01
506	2018-01-01
506	2017-01-01	BEN CROW