401k Plan data: HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN plan

HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN
Plan identification number	002

HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 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.
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

HOMETOWN BANK, NA has sponsored the creation of one or more 401k plans.

Company Name: HOMETOWN BANK, NA

Employer identification number (EIN): 741541411

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2023-01-01 ERIKA ANGELL 2024-10-14
002 2022-01-01
002 2021-01-01
002 2020-01-01 ALLAN J RASMUSSEN 2021-07-21 ALLAN J RASMUSSEN 2021-07-21
002 2019-01-01 ALLAN J RASMUSSEN 2020-07-24 ALLAN J RASMUSSEN 2020-07-24
002 2018-01-01 ALLAN J RASMUSSEN 2019-06-14 ALLAN J RASMUSSEN 2019-06-14
002 2017-01-01 ALLAN J RASMUSSEN 2018-06-05 ALLAN J RASMUSSEN 2018-06-05
002 2016-01-01 A. J. RASMUSSEN 2017-07-12
002 2015-01-01 ALLAN J. RASMUSSEN 2016-07-25 ALLAN J. RASMUSSEN 2016-07-25
002 2014-01-01 ALLAN J. RASMUSSEN 2015-09-25 ALLAN J. RASMUSSEN 2015-09-25
002 2013-01-01 ALLAN J. RASMUSSEN 2014-07-18 ALLAN J. RASMUSSEN 2014-07-18
002 2012-01-01 ALLAN J. RASMUSSEN 2013-07-10 ALLAN J. RASMUSSEN 2013-07-10
002 2011-01-01 ALLAN J. RASMUSSEN 2012-06-06 ALLAN J. RASMUSSEN 2012-06-06
002 2010-01-01 ALLAN J. RASMUSSEN 2011-06-02 ALLAN J. RASMUSSEN 2011-06-02

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2023-01-01	ERIKA ANGELL	2024-10-14
002	2022-01-01
002	2021-01-01
002	2020-01-01	ALLAN J RASMUSSEN	2021-07-21	ALLAN J RASMUSSEN	2021-07-21
002	2019-01-01	ALLAN J RASMUSSEN	2020-07-24	ALLAN J RASMUSSEN	2020-07-24
002	2018-01-01	ALLAN J RASMUSSEN	2019-06-14	ALLAN J RASMUSSEN	2019-06-14
002	2017-01-01	ALLAN J RASMUSSEN	2018-06-05	ALLAN J RASMUSSEN	2018-06-05
002	2016-01-01	A. J. RASMUSSEN	2017-07-12
002	2015-01-01	ALLAN J. RASMUSSEN	2016-07-25	ALLAN J. RASMUSSEN	2016-07-25
002	2014-01-01	ALLAN J. RASMUSSEN	2015-09-25	ALLAN J. RASMUSSEN	2015-09-25
002	2013-01-01	ALLAN J. RASMUSSEN	2014-07-18	ALLAN J. RASMUSSEN	2014-07-18
002	2012-01-01	ALLAN J. RASMUSSEN	2013-07-10	ALLAN J. RASMUSSEN	2013-07-10
002	2011-01-01	ALLAN J. RASMUSSEN	2012-06-06	ALLAN J. RASMUSSEN	2012-06-06
002	2010-01-01	ALLAN J. RASMUSSEN	2011-06-02	ALLAN J. RASMUSSEN	2011-06-02

Plan Statistics for HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN

401k plan membership statisitcs for HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN

Measure Date Value
2023: HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 106
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 13
Total of all active and inactive participants 2023-01-01 119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 119
Number of participants with account balances 2023-01-01 96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 2
2022: HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 98
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 18
Total of all active and inactive participants 2022-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 116
Number of participants with account balances 2022-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 6
2021: HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 100
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 16
Total of all active and inactive participants 2021-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 116
Number of participants with account balances 2021-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 7

Measure	Date	Value
2023: HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	106
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	13
Total of all active and inactive participants	2023-01-01	119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	119
Number of participants with account balances	2023-01-01	96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	2
2022: HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	98
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	18
Total of all active and inactive participants	2022-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	116
Number of participants with account balances	2022-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	6
2021: HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	100
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	16
Total of all active and inactive participants	2021-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	116
Number of participants with account balances	2021-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	7

Financial Data on HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN

Measure	Date	Value
2023 : HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total income from all sources (including contributions)	2023-12-31	$1,507,732
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$795,522
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$778,531
Value of total corrective distributions	2023-12-31	$14,721
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$550,462
Value of total assets at end of year	2023-12-31	$6,560,952
Value of total assets at beginning of year	2023-12-31	$5,848,742
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$2,270
Total interest from all sources	2023-12-31	$5,337
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-12-31	No
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2023-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-12-31	No
Contributions received from participants	2023-12-31	$421,058
Assets. Other investments not covered elsewhere at end of year	2023-12-31	$3,353
Assets. Other investments not covered elsewhere at beginning of year	2023-12-31	$3,353
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Value of net income/loss	2023-12-31	$712,210
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$6,560,952
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$5,848,742
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-12-31	No
Were any leases to which the plan was party in default or uncollectible	2023-12-31	No
Value of interest in pooled separate accounts at end of year	2023-12-31	$6,244,359
Value of interest in pooled separate accounts at beginning of year	2023-12-31	$5,321,869
Interest earned on other investments	2023-12-31	$5,337
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2023-12-31	$313,240
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2023-12-31	$523,520
Net investment gain/loss from pooled separate accounts	2023-12-31	$951,933
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-12-31	No
Was there a failure to transmit to the plan any participant contributions	2023-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2023-12-31	No
Contributions received in cash from employer	2023-12-31	$129,404
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$778,531
Contract administrator fees	2023-12-31	$2,270
Did the plan have assets held for investment	2023-12-31	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	2023-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-12-31	No
Opinion of an independent qualified public accountant for this plan	2023-12-31	Unqualified
Accountancy firm name	2023-12-31	WHITLEY PENN LLP
Accountancy firm EIN	2023-12-31	752393478
2022 : HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-550,019
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$1,784,868
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,756,849
Value of total corrective distributions	2022-12-31	$25,136
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$627,680
Value of total assets at end of year	2022-12-31	$5,848,742
Value of total assets at beginning of year	2022-12-31	$8,183,629
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$2,883
Total interest from all sources	2022-12-31	$6,652
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$439,124
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$3,353
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$12,249
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$40,948
Other income not declared elsewhere	2022-12-31	$-8,896
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-2,334,887
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$5,848,742
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$8,183,629
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in pooled separate accounts at end of year	2022-12-31	$5,321,869
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$6,874,430
Interest earned on other investments	2022-12-31	$6,652
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$523,520
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$1,296,950
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$1,537
Net investment gain/loss from pooled separate accounts	2022-12-31	$-1,175,455
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$147,608
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$1,755,312
Contract administrator fees	2022-12-31	$2,883
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	WHITLEY PENN LLP
Accountancy firm EIN	2022-12-31	752393478
2021 : HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
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	$1,501,337
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$524,711
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$504,568
Value of total corrective distributions	2021-12-31	$19,115
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$630,786
Value of total assets at end of year	2021-12-31	$8,183,629
Value of total assets at beginning of year	2021-12-31	$7,207,003
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$1,028
Total interest from all sources	2021-12-31	$13,265
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
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	Yes
Value of fidelity bond cover	2021-12-31	$2,000,000
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	$469,760
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$12,249
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$12,249
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$7,146
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	$976,626
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$8,183,629
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$7,207,003
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 pooled separate accounts at end of year	2021-12-31	$6,874,430
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$5,793,284
Interest earned on other investments	2021-12-31	$13,265
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$1,296,950
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$1,401,470
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$1,537
Net investment gain/loss from pooled separate accounts	2021-12-31	$857,286
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	$153,880
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$503,031
Contract administrator fees	2021-12-31	$1,028
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	Unqualified
Accountancy firm name	2021-12-31	WHITLEY PENN LLP
Accountancy firm EIN	2021-12-31	752393478

Form 5500 Responses for HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN

2023: HOMETOWN BANK NA 401 (K) PROFIT SHARING PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	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	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: HOMETOWN BANK NA 401 (K) PROFIT SHARING 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 – 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: HOMETOWN BANK NA 401 (K) PROFIT SHARING 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 – 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

Insurance Providers Used on plan

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

068769

Policy instance

Insurance contract or identification number	068769
Number of Individuals Covered	119
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $24,425
Total amount of fees paid to insurance company	USD $0
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?	Yes
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

AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )

Policy contract number

U0278322

Policy instance

Insurance contract or identification number	U0278322
Number of Individuals Covered	1
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	1
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
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

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

068769

Policy instance

Insurance contract or identification number	068769
Number of Individuals Covered	116
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $24,382
Total amount of fees paid to insurance company	USD $0
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?	Yes
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 $24,382
Insurance broker organization code?	3

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

068769

Policy instance

Insurance contract or identification number	068769
Number of Individuals Covered	116
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $31,031
Total amount of fees paid to insurance company	USD $0
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?	Yes
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
Commission paid to Insurance Broker	USD $31,031
Insurance broker organization code?	3

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Company Name:	HOMETOWN BANK, NA
Employer identification number (EIN):	741541411
NAIC Classification:	522110
NAIC Description:	Commercial Banking