401k Plan data: CSI RETIREMENT PLAN B plan

CSI RETIREMENT PLAN B 401k Plan overview

Plan Name	CSI RETIREMENT PLAN B
Plan identification number	002

CSI RETIREMENT PLAN B Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.

401k Sponsoring company profile

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

Company Name: COMMUNITY SERVICES, INC.

Employer identification number (EIN): 930984702

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CSI RETIREMENT PLAN B

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01
002 2021-01-01
002 2020-01-01 WARREN KLINKENBERG 2021-02-24
002 2019-01-01
002 2018-01-01 WARREN KLINKENBERG 2019-07-25
002 2017-01-01 WARREN KLINKENBERG 2018-04-09 WARREN KLINKENBERG 2018-04-09
002 2017-01-01 WARREN KLINKENBERG 2018-05-08 WARREN KLINKENBERG 2018-05-08
002 2016-01-01 KELLY THRAN 2017-10-06
002 2016-01-01 KELLY THRAN 2017-11-27
002 2015-01-01 LYNNE BOOSE, PH.D. 2016-10-11
002 2014-01-01 LYNNE BOOSE, PH.D. 2015-09-09
002 2013-01-01 LYNNE BOOSE, PH.D. 2014-10-13
002 2012-01-01 LYNNE BOOSE, PH.D. 2013-10-07
002 2011-01-01 LYNNE BOOSE, PH.D. 2012-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01
002	2021-01-01
002	2021-01-01
002	2020-01-01	WARREN KLINKENBERG	2021-02-24
002	2019-01-01
002	2018-01-01	WARREN KLINKENBERG	2019-07-25
002	2017-01-01	WARREN KLINKENBERG	2018-04-09	WARREN KLINKENBERG	2018-04-09
002	2017-01-01	WARREN KLINKENBERG	2018-05-08	WARREN KLINKENBERG	2018-05-08
002	2016-01-01	KELLY THRAN	2017-10-06
002	2016-01-01	KELLY THRAN	2017-11-27
002	2015-01-01	LYNNE BOOSE, PH.D.	2016-10-11
002	2014-01-01	LYNNE BOOSE, PH.D.	2015-09-09
002	2013-01-01	LYNNE BOOSE, PH.D.	2014-10-13
002	2012-01-01	LYNNE BOOSE, PH.D.	2013-10-07
002	2011-01-01	LYNNE BOOSE, PH.D.	2012-10-15

Plan Statistics for CSI RETIREMENT PLAN B

401k plan membership statisitcs for CSI RETIREMENT PLAN B

Measure Date Value
2022: CSI RETIREMENT PLAN B 2022 401k membership
Total participants, beginning-of-year 2022-01-01 95
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 88
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 48
Total of all active and inactive participants 2022-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 136
Number of participants with account balances 2022-01-01 90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: CSI RETIREMENT PLAN B 2021 401k membership
Total participants, beginning-of-year 2021-01-01 107
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 60
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 35
Total of all active and inactive participants 2021-01-01 95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 96
Number of participants with account balances 2021-01-01 95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2019: CSI RETIREMENT PLAN B 2019 401k membership
Total participants, beginning-of-year 2019-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 73
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 26
Total of all active and inactive participants 2019-01-01 99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 99
Number of participants with account balances 2019-01-01 99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0

Measure	Date	Value
2022: CSI RETIREMENT PLAN B 2022 401k membership
Total participants, beginning-of-year	2022-01-01	95
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	88
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	48
Total of all active and inactive participants	2022-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	136
Number of participants with account balances	2022-01-01	90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: CSI RETIREMENT PLAN B 2021 401k membership
Total participants, beginning-of-year	2021-01-01	107
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	60
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	35
Total of all active and inactive participants	2021-01-01	95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	96
Number of participants with account balances	2021-01-01	95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2019: CSI RETIREMENT PLAN B 2019 401k membership
Total participants, beginning-of-year	2019-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	73
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	26
Total of all active and inactive participants	2019-01-01	99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	99
Number of participants with account balances	2019-01-01	99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0

Financial Data on CSI RETIREMENT PLAN B

Measure	Date	Value
2022 : CSI RETIREMENT PLAN B 2022 401k financial data
Total plan liabilities at beginning of year	2022-12-31	$0
Total income from all sources	2022-12-31	$-140,730
Expenses. Total of all expenses incurred	2022-12-31	$145,603
Benefits paid (including direct rollovers)	2022-12-31	$138,970
Total plan assets at end of year	2022-12-31	$1,536,770
Total plan assets at beginning of year	2022-12-31	$1,823,103
Value of fidelity bond covering the plan	2022-12-31	$500,000
Total contributions received or receivable from participants	2022-12-31	$67,179
Expenses. Other expenses not covered elsewhere	2022-12-31	$5,279
Contributions received from other sources (not participants or employers)	2022-12-31	$-255,814
Other income received	2022-12-31	$1,582
Net income (gross income less expenses)	2022-12-31	$-286,333
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$1,536,770
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$1,823,103
Total contributions received or receivable from employer(s)	2022-12-31	$46,323
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$1,354
2021 : CSI RETIREMENT PLAN B 2021 401k financial data
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	$469,310
Total of all expenses incurred	2021-12-31	$151,655
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$130,466
Expenses. Certain deemed distributions of participant loans	2021-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$240,602
Value of total assets at end of year	2021-12-31	$1,823,103
Value of total assets at beginning of year	2021-12-31	$1,505,448
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$21,189
Total interest from all sources	2021-12-31	$3,407
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	$469,310
Expenses. Total of all expenses incurred	2021-12-31	$151,655
Benefits paid (including direct rollovers)	2021-12-31	$130,466
Total plan assets at end of year	2021-12-31	$1,823,103
Total plan assets at beginning of year	2021-12-31	$1,505,448
Value of fidelity bond covering the plan	2021-12-31	$500,000
Total contributions received or receivable from participants	2021-12-31	$76,737
Expenses. Other expenses not covered elsewhere	2021-12-31	$21,189
Contributions received from other sources (not participants or employers)	2021-12-31	$2,925
Other income received	2021-12-31	$226,167
Net income (gross income less expenses)	2021-12-31	$317,655
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$1,823,103
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$1,505,448
Total contributions received or receivable from employer(s)	2021-12-31	$163,481
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	No
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$76,737
Participant contributions at end of year	2021-12-31	$56,623
Participant contributions at beginning of year	2021-12-31	$64,887
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$383
Other income not declared elsewhere	2021-12-31	$0
Administrative expenses (other) incurred	2021-12-31	$21,189
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$317,655
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,823,103
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$1,505,448
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$1,668,359
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$1,365,715
Interest on participant loans	2021-12-31	$2,541
Interest earned on other investments	2021-12-31	$866
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$98,121
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$74,846
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$0
Net investment gain/loss from pooled separate accounts	2021-12-31	$225,301
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$163,482
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$130,466
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
2019 : CSI RETIREMENT PLAN B 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$351,833
Expenses. Total of all expenses incurred	2019-12-31	$57,116
Benefits paid (including direct rollovers)	2019-12-31	$53,765
Total plan assets at end of year	2019-12-31	$1,265,177
Total plan assets at beginning of year	2019-12-31	$970,460
Value of fidelity bond covering the plan	2019-12-31	$500,000
Total contributions received or receivable from participants	2019-12-31	$62,408
Expenses. Other expenses not covered elsewhere	2019-12-31	$3,351
Contributions received from other sources (not participants or employers)	2019-12-31	$3,517
Other income received	2019-12-31	$186,311
Net income (gross income less expenses)	2019-12-31	$294,717
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$1,265,177
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$970,460
Total contributions received or receivable from employer(s)	2019-12-31	$99,597
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0

Form 5500 Responses for CSI RETIREMENT PLAN B

2022: CSI RETIREMENT PLAN B 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
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	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: CSI RETIREMENT PLAN B 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 – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2019: CSI RETIREMENT PLAN B 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 – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

061198

Policy instance

Insurance contract or identification number	061198
Number of Individuals Covered	136
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 $293
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	1
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
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
Amount paid for insurance broker fees	293
Additional information about fees paid to insurance broker	INCENTIVE COMPENSATION
Insurance broker organization code?	3

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

061199B

Policy instance

Insurance contract or identification number	061199B
Number of Individuals Covered	96
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 $299
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	1
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
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 Broker	USD $0
Amount paid for insurance broker fees	299
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

061199B

Policy instance

Insurance contract or identification number	061199B
Number of Individuals Covered	99
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $489
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	1
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
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 Broker	USD $0
Amount paid for insurance broker fees	489
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

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Company Name:	COMMUNITY SERVICES, INC.
Employer identification number (EIN):	930984702
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities