401k Plan data: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN plan

APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 401k Plan overview

Plan Name	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN
Plan identification number	001

APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) 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.
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.
Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
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

APPALACHIAN AGENCY FOR SENIOR CITIZENS has sponsored the creation of one or more 401k plans.

Company Name: APPALACHIAN AGENCY FOR SENIOR CITIZENS

Employer identification number (EIN): 540990533

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 BRIAN BECK 2023-10-09 BRIAN BECK 2023-10-09
001 2021-01-01 BRIAN BECK 2022-10-13 BRIAN BECK 2022-10-13
001 2020-01-01
001 2019-01-01 REGINA SAYERS 2020-10-13 REGINA SAYERS 2020-10-13
001 2018-01-01 REGINA SAYERS 2019-10-15 REGINA SAYERS 2019-10-15
001 2017-01-01 REGINA SAYERS 2018-10-11 REGINA SAYERS 2018-10-11
001 2017-01-01 REGINA SAYERS 2019-10-10 REGINA SAYERS 2019-10-10
001 2016-01-01 REGINA SAYERS 2017-10-13 REGINA SAYERS 2017-10-13
001 2015-01-01 REGINA SAYERS 2016-10-10 REGINA SAYERS 2016-10-10
001 2014-01-01 REGINA SAYERS 2015-10-09 REGINA SAYERS 2015-10-09
001 2013-01-01 REGINA SAYERS 2014-10-14 REGINA SAYERS 2014-10-14
001 2012-01-01 REGINA SAYERS
001 2011-01-01 REGINA SAYERS
001 2010-01-01 REGINA SAYERS
001 2009-01-01 CAROLYN COUNTS
001 2009-01-01 CAROLYN COUNTS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	BRIAN BECK	2023-10-09	BRIAN BECK	2023-10-09
001	2021-01-01	BRIAN BECK	2022-10-13	BRIAN BECK	2022-10-13
001	2020-01-01
001	2019-01-01	REGINA SAYERS	2020-10-13	REGINA SAYERS	2020-10-13
001	2018-01-01	REGINA SAYERS	2019-10-15	REGINA SAYERS	2019-10-15
001	2017-01-01	REGINA SAYERS	2018-10-11	REGINA SAYERS	2018-10-11
001	2017-01-01	REGINA SAYERS	2019-10-10	REGINA SAYERS	2019-10-10
001	2016-01-01	REGINA SAYERS	2017-10-13	REGINA SAYERS	2017-10-13
001	2015-01-01	REGINA SAYERS	2016-10-10	REGINA SAYERS	2016-10-10
001	2014-01-01	REGINA SAYERS	2015-10-09	REGINA SAYERS	2015-10-09
001	2013-01-01	REGINA SAYERS	2014-10-14	REGINA SAYERS	2014-10-14
001	2012-01-01	REGINA SAYERS
001	2011-01-01	REGINA SAYERS
001	2010-01-01	REGINA SAYERS
001	2009-01-01	CAROLYN COUNTS
001	2009-01-01	CAROLYN COUNTS

Plan Statistics for APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN

401k plan membership statisitcs for APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN

Measure Date Value
2022: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 261
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 225
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 34
Total of all active and inactive participants 2022-01-01 259
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 2
Total participants 2022-01-01 261
Number of participants with account balances 2022-01-01 111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 5
2021: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 144
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 26
Total of all active and inactive participants 2021-01-01 170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 2
Total participants 2021-01-01 172
Number of participants with account balances 2021-01-01 98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 6
2020: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 115
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 23
Total of all active and inactive participants 2020-01-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 138
Number of participants with account balances 2020-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 2
2019: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 233
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 280
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 18
Total of all active and inactive participants 2019-01-01 298
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 298
Number of participants with account balances 2019-01-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 2
2012: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 78
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 78
Total of all active and inactive participants 2012-01-01 78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 2
Total participants 2012-01-01 80
2011: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 69
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 74
Number of retired or separated participants receiving benefits 2011-01-01 4
Total of all active and inactive participants 2011-01-01 78
Total participants 2011-01-01 78
2010: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 37
Total of all active and inactive participants 2010-01-01 37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 1
Total participants 2010-01-01 38
2009: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 61
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 37
Number of retired or separated participants receiving benefits 2009-01-01 2
Number of other retired or separated participants entitled to future benefits 2009-01-01 32
Total of all active and inactive participants 2009-01-01 71
Total participants 2009-01-01 71

Measure	Date	Value
2022: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	261
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	225
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	34
Total of all active and inactive participants	2022-01-01	259
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	2
Total participants	2022-01-01	261
Number of participants with account balances	2022-01-01	111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	5
2021: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	144
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	26
Total of all active and inactive participants	2021-01-01	170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	2
Total participants	2021-01-01	172
Number of participants with account balances	2021-01-01	98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	6
2020: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	115
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	23
Total of all active and inactive participants	2020-01-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	138
Number of participants with account balances	2020-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	2
2019: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	233
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	280
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	18
Total of all active and inactive participants	2019-01-01	298
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	298
Number of participants with account balances	2019-01-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	2
2012: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	78
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	78
Total of all active and inactive participants	2012-01-01	78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	2
Total participants	2012-01-01	80
2011: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	69
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	74
Number of retired or separated participants receiving benefits	2011-01-01	4
Total of all active and inactive participants	2011-01-01	78
Total participants	2011-01-01	78
2010: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	37
Total of all active and inactive participants	2010-01-01	37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	1
Total participants	2010-01-01	38
2009: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	61
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	37
Number of retired or separated participants receiving benefits	2009-01-01	2
Number of other retired or separated participants entitled to future benefits	2009-01-01	32
Total of all active and inactive participants	2009-01-01	71
Total participants	2009-01-01	71

Financial Data on APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN

Measure	Date	Value
2022 : APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2022-12-31	$-676,632
Total unrealized appreciation/depreciation of assets	2022-12-31	$-676,632
Total income from all sources (including contributions)	2022-12-31	$-217,080
Total of all expenses incurred	2022-12-31	$198,361
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$186,681
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$402,154
Value of total assets at end of year	2022-12-31	$3,468,072
Value of total assets at beginning of year	2022-12-31	$3,883,513
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$11,680
Total interest from all sources	2022-12-31	$1,026
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$56,372
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$56,372
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$150,000
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	$189,170
Participant contributions at beginning of year	2022-12-31	$0
Assets. Loans (other than to participants) at end of year	2022-12-31	$19,290
Assets. Loans (other than to participants) at beginning of year	2022-12-31	$27,246
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	$-415,441
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$3,468,072
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$3,883,513
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 registered invesment companies (eg mutual funds) at end of year	2022-12-31	$2,422,618
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$2,647,233
Income. Interest from loans (other than to participants)	2022-12-31	$1,026
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$1,026,164
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$1,190,614
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	$212,984
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$18,420
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$186,681
Contract administrator fees	2022-12-31	$11,680
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	LALLY & CO, LLC
Accountancy firm EIN	2022-12-31	251846963
2021 : APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2021-12-31	$335,414
Total unrealized appreciation/depreciation of assets	2021-12-31	$335,414
Total income from all sources (including contributions)	2021-12-31	$841,017
Total of all expenses incurred	2021-12-31	$306,763
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$295,808
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	$445,571
Value of total assets at end of year	2021-12-31	$3,883,513
Value of total assets at beginning of year	2021-12-31	$3,349,259
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$10,955
Total interest from all sources	2021-12-31	$926
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$59,106
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$59,106
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$150,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$156,773
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$6,014
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$87,615
Assets. Loans (other than to participants) at end of year	2021-12-31	$27,246
Assets. Loans (other than to participants) at beginning of year	2021-12-31	$14,719
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	$534,254
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$3,883,513
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$3,349,259
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
Investment advisory and management fees	2021-12-31	$10,955
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$2,647,233
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,105,782
Interest on participant loans	2021-12-31	$926
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$1,190,614
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$1,194,604
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$0
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	$201,183
Employer contributions (assets) at end of year	2021-12-31	$18,420
Employer contributions (assets) at beginning of year	2021-12-31	$28,140
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$295,808
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	LALLY & CO, LLC
Accountancy firm EIN	2021-12-31	251846963
2020 : APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2020-12-31	$98,621
Total unrealized appreciation/depreciation of assets	2020-12-31	$98,621
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$900,596
Total of all expenses incurred	2020-12-31	$431,819
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$410,267
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$494,717
Value of total assets at end of year	2020-12-31	$3,349,259
Value of total assets at beginning of year	2020-12-31	$2,880,482
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$21,552
Total interest from all sources	2020-12-31	$7,451
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$36,818
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$36,818
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$150,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$135,688
Participant contributions at end of year	2020-12-31	$6,014
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$157,639
Assets. Loans (other than to participants) at end of year	2020-12-31	$14,719
Assets. Loans (other than to participants) at beginning of year	2020-12-31	$5,822
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$0
Other income not declared elsewhere	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$468,777
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,349,259
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,880,482
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$21,552
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,105,782
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$2,324,779
Interest on participant loans	2020-12-31	$352
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$7,099
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$1,194,604
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$548,969
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$262,989
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$201,390
Employer contributions (assets) at end of year	2020-12-31	$28,140
Employer contributions (assets) at beginning of year	2020-12-31	$912
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$410,267
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Liabilities. Value of acquisition indebtedness at beginning of year	2020-12-31	$0
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	LALLY & CO, LLC
Accountancy firm EIN	2020-12-31	251846963
2019 : APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$709,497
Total income from all sources (including contributions)	2019-12-31	$709,497
Total of all expenses incurred	2019-12-31	$165,195
Total of all expenses incurred	2019-12-31	$165,195
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$151,042
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$151,042
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$284,382
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$284,382
Value of total assets at end of year	2019-12-31	$2,880,482
Value of total assets at end of year	2019-12-31	$2,880,482
Value of total assets at beginning of year	2019-12-31	$2,336,180
Value of total assets at beginning of year	2019-12-31	$2,336,180
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$14,153
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$14,153
Total interest from all sources	2019-12-31	$1,392
Total interest from all sources	2019-12-31	$1,392
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$195,723
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$195,723
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$150,000
Value of fidelity bond cover	2019-12-31	$150,000
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
If this is an individual account plan, was there a blackout period	2019-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$118,216
Contributions received from participants	2019-12-31	$118,216
Participant contributions at beginning of year	2019-12-31	$4,858
Participant contributions at beginning of year	2019-12-31	$4,858
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$11,429
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$11,429
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2019-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2019-12-31	$0
Assets. Loans (other than to participants) at end of year	2019-12-31	$5,822
Assets. Loans (other than to participants) at end of year	2019-12-31	$5,822
Assets. Loans (other than to participants) at beginning of year	2019-12-31	$7,461
Assets. Loans (other than to participants) at beginning of year	2019-12-31	$7,461
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$0
Administrative expenses (other) incurred	2019-12-31	$0
Administrative expenses (other) incurred	2019-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$544,302
Value of net income/loss	2019-12-31	$544,302
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,880,482
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,880,482
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,336,180
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,336,180
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$14,153
Investment advisory and management fees	2019-12-31	$14,153
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,324,779
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,324,779
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,717,858
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,717,858
Interest on participant loans	2019-12-31	$417
Interest on participant loans	2019-12-31	$417
Income. Interest from loans (other than to participants)	2019-12-31	$0
Income. Interest from loans (other than to participants)	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$49
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$49
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$49
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$49
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$975
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$975
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$548,969
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$548,969
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$598,105
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$598,105
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$228,000
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$228,000
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$154,737
Contributions received in cash from employer	2019-12-31	$154,737
Employer contributions (assets) at end of year	2019-12-31	$912
Employer contributions (assets) at end of year	2019-12-31	$912
Employer contributions (assets) at beginning of year	2019-12-31	$7,849
Employer contributions (assets) at beginning of year	2019-12-31	$7,849
Income. Dividends from common stock	2019-12-31	$195,723
Income. Dividends from common stock	2019-12-31	$195,723
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$151,042
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$151,042
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Liabilities. Value of acquisition indebtedness at end of year	2019-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2019-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	LALLY & CO, LLC
Accountancy firm name	2019-12-31	LALLY & CO, LLC
Accountancy firm EIN	2019-12-31	251846963
Accountancy firm EIN	2019-12-31	251846963
2012 : APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$-685
Total plan liabilities at end of year	2012-12-31	$74,990
Total plan liabilities at beginning of year	2012-12-31	$33,827
Total income from all sources	2012-12-31	$235,976
Expenses. Total of all expenses incurred	2012-12-31	$125,738
Benefits paid (including direct rollovers)	2012-12-31	$121,008
Total plan assets at end of year	2012-12-31	$1,395,299
Total plan assets at beginning of year	2012-12-31	$1,285,746
Total contributions received or receivable from participants	2012-12-31	$44,736
Expenses. Other expenses not covered elsewhere	2012-12-31	$2
Contributions received from other sources (not participants or employers)	2012-12-31	$9,171
Other income received	2012-12-31	$80,179
Net income (gross income less expenses)	2012-12-31	$110,238
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,395,299
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,285,746
Assets. Value of participant loans	2012-12-31	$2,843
Total contributions received or receivable from employer(s)	2012-12-31	$101,890
Value of certain deemed distributions of participant loans	2012-12-31	$1,522
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$3,206
2011 : APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$3,603
Total plan liabilities at end of year	2011-12-31	$33,827
Total income from all sources	2011-12-31	$104,704
Expenses. Total of all expenses incurred	2011-12-31	$46,999
Benefits paid (including direct rollovers)	2011-12-31	$33,827
Total plan assets at end of year	2011-12-31	$1,185,795
Total plan assets at beginning of year	2011-12-31	$1,090,660
Total contributions received or receivable from participants	2011-12-31	$40,147
Expenses. Other expenses not covered elsewhere	2011-12-31	$13,172
Contributions received from other sources (not participants or employers)	2011-12-31	$11,244
Other income received	2011-12-31	$-35,341
Net income (gross income less expenses)	2011-12-31	$57,705
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,151,968
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,090,660
Assets. Value of participant loans	2011-12-31	$5,367
Total contributions received or receivable from employer(s)	2011-12-31	$88,654
2010 : APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$211,080
Total plan liabilities at beginning of year	2010-12-31	$200,691
Total income from all sources	2010-12-31	$186,079
Expenses. Total of all expenses incurred	2010-12-31	$223,351
Benefits paid (including direct rollovers)	2010-12-31	$211,080
Total plan assets at end of year	2010-12-31	$1,090,870
Total plan assets at beginning of year	2010-12-31	$1,117,753
Total contributions received or receivable from participants	2010-12-31	$34,588
Expenses. Other expenses not covered elsewhere	2010-12-31	$12,271
Other income received	2010-12-31	$70,985
Net income (gross income less expenses)	2010-12-31	$-37,272
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$879,790
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$917,062
Total contributions received or receivable from employer(s)	2010-12-31	$80,506

Form 5500 Responses for APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN

2022: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) 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: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) 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
2020: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) 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 – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) 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 – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2012: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC. 403(B) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	First time form 5500 has been submitted	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

506324-01

Policy instance

Insurance contract or identification number	506324-01
Number of Individuals Covered	1
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

506324-01

Policy instance

Insurance contract or identification number	506324-01
Number of Individuals Covered	1
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
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

506324-01

Policy instance

Insurance contract or identification number	506324-01
Number of Individuals Covered	1
Insurance policy start date	2020-01-01
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
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

506324-01

Policy instance

Insurance contract or identification number	506324-01
Number of Individuals Covered	2
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

706930 001

Policy instance

Insurance contract or identification number	706930 001
Number of Individuals Covered	80
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,241
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Are there contracts with allocated funds for individual policies?	No
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 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 $4,241
Insurance broker organization code?	3
Insurance broker name	B HATCH JR, CFP

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

706930 001

Policy instance

Insurance contract or identification number	706930 001
Number of Individuals Covered	78
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,817
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

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

706930 001

Policy instance

Insurance contract or identification number	706930 001
Number of Individuals Covered	69
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,211
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
Commission paid to Insurance Broker	USD $1,307
Insurance broker organization code?	3
Insurance broker name	W. LAWSON, CHFC, CLU

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Company Name:	APPALACHIAN AGENCY FOR SENIOR CITIZENS
Employer identification number (EIN):	540990533
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities