401k Plan data: PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN plan

PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN 401k Plan overview

Plan Name	PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN
Plan identification number	502

PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

PEOPLES STATE BANK OF PRAIRIE DU CHIEN has sponsored the creation of one or more 401k plans.

Company Name: PEOPLES STATE BANK OF PRAIRIE DU CHIEN

Employer identification number (EIN): 390532620

NAIC Classification: 551111
NAIC Description: Offices of Bank Holding Companies

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-01-01
502 2022-01-01
502 2019-01-01 ROSHINI MENDIS 2022-08-14

Plan Statistics for PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN

401k plan membership statisitcs for PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN

Measure Date Value
2023: PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 113
Total participants, beginning-of-year 2023-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 103
Number of retired or separated participants receiving benefits 2023-01-01 2
Number of retired or separated participants receiving benefits 2023-01-01 2
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 105
Total of all active and inactive participants 2023-01-01 105
Total participants 2023-01-01 105
Total participants 2023-01-01 105
2022: PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 113
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 2022-01-01 113
Total participants 2022-01-01 113
2019: PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 98
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 98

Measure	Date	Value
2023: PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	113
Total participants, beginning-of-year	2023-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	103
Number of retired or separated participants receiving benefits	2023-01-01	2
Number of retired or separated participants receiving benefits	2023-01-01	2
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	105
Total of all active and inactive participants	2023-01-01	105
Total participants	2023-01-01	105
Total participants	2023-01-01	105
2022: PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	113
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	113
Total participants	2022-01-01	113
2019: PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	98
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	98

Form 5500 Responses for PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN

2023: PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH 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
2019: PEOPLES STATE BANK OF PRAIRIE DU CHIEN SELF-INSURED SUPPLEMENTAL HEALTH PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
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

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Company Name:	PEOPLES STATE BANK OF PRAIRIE DU CHIEN
Employer identification number (EIN):	390532620
NAIC Classification:	551111
NAIC Description:	Offices of Bank Holding Companies