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LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 401k Plan overview

Plan NameLAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN
Plan identification number 001

LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Money purchase (other than target benefit)
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.

401k Sponsoring company profile

LAKE COUNTRY AREA AGENCY ON AGING has sponsored the creation of one or more 401k plans.

Company Name:LAKE COUNTRY AREA AGENCY ON AGING
Employer identification number (EIN):541506078
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01MARVALENE JOHNSON2023-10-16 MARVALENE JOHNSON2023-10-16
0012021-01-01HOLLY SLUDER2022-07-20 HOLLY SLUDER2022-07-20
0012020-01-01GWEN HINZMAN2021-07-28 GWEN HINZMAN2021-07-28
0012019-01-01GWEN HINZMAN2020-07-22 GWEN HINZMAN2020-07-22
0012018-01-01TRINA STAHL
0012017-01-01GLENN E. BARBOUR
0012016-01-01GLENN E. BARBOUR
0012015-01-01GLENN E. BARBOUR
0012014-01-01GLENN E. BARBOUR
0012013-01-01GLENN E. BARBOUR
0012012-01-01GLENN E. BARBOUR
0012011-01-01GLENN E. BARBOUR
0012009-01-01GLENN E. BARBOUR
0012009-01-01GLENN E. BARBOUR

Plan Statistics for LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN

401k plan membership statisitcs for LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN

Measure Date Value
2022: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0150
Total number of active participants reported on line 7a of the Form 55002022-01-0155
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-0155
Number of participants with account balances2022-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0156
Total number of active participants reported on line 7a of the Form 55002021-01-0150
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0150
Number of participants with account balances2021-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0154
Total number of active participants reported on line 7a of the Form 55002020-01-0156
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-0156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0156
Number of participants with account balances2020-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0157
Total number of active participants reported on line 7a of the Form 55002019-01-0154
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-0154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0154
Number of participants with account balances2019-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0157
Total number of active participants reported on line 7a of the Form 55002018-01-0157
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-010
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-010
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-010
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-010
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0157
Total of all active and inactive participants2013-01-010
Total participants2013-01-010
2012: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0161
Total number of active participants reported on line 7a of the Form 55002012-01-0157
Total of all active and inactive participants2012-01-0157
Total participants2012-01-0157
2011: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0165
Total number of active participants reported on line 7a of the Form 55002011-01-0161
Total of all active and inactive participants2011-01-0161
Total participants2011-01-0161
2009: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0117
Total number of active participants reported on line 7a of the Form 55002009-01-0117
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0117
Number of participants with account balances2009-01-0139

Financial Data on LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN

Measure Date Value
2022 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2022 401k financial data
Transfers to/from the plan2022-12-31$38,532
Total plan liabilities at end of year2022-12-31$67,636
Total plan liabilities at beginning of year2022-12-31$74,528
Total income from all sources2022-12-31$-75,246
Expenses. Total of all expenses incurred2022-12-31$81,914
Benefits paid (including direct rollovers)2022-12-31$67,636
Total plan assets at end of year2022-12-31$992,173
Total plan assets at beginning of year2022-12-31$1,117,693
Total contributions received or receivable from participants2022-12-31$6,240
Expenses. Other expenses not covered elsewhere2022-12-31$4,507
Contributions received from other sources (not participants or employers)2022-12-31$0
Other income received2022-12-31$-115,674
Noncash contributions received2022-12-31$0
Net income (gross income less expenses)2022-12-31$-157,160
Net plan assets at end of year (total assets less liabilities)2022-12-31$924,537
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$1,043,165
Assets. Value of participant loans2022-12-31$12,819
Total contributions received or receivable from employer(s)2022-12-31$34,188
Value of certain deemed distributions of participant loans2022-12-31$2,653
Value of corrective distributions2022-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$7,118
2021 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2021 401k financial data
Transfers to/from the plan2021-12-31$99,910
Total plan liabilities at end of year2021-12-31$74,528
Total plan liabilities at beginning of year2021-12-31$39,720
Total income from all sources2021-12-31$18,950
Expenses. Total of all expenses incurred2021-12-31$86,707
Benefits paid (including direct rollovers)2021-12-31$74,528
Total plan assets at end of year2021-12-31$1,117,693
Total plan assets at beginning of year2021-12-31$1,050,732
Total contributions received or receivable from participants2021-12-31$12,980
Expenses. Other expenses not covered elsewhere2021-12-31$1,030
Contributions received from other sources (not participants or employers)2021-12-31$0
Other income received2021-12-31$-32,644
Noncash contributions received2021-12-31$0
Net income (gross income less expenses)2021-12-31$-67,757
Net plan assets at end of year (total assets less liabilities)2021-12-31$1,043,165
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$1,011,012
Assets. Value of participant loans2021-12-31$18,602
Total contributions received or receivable from employer(s)2021-12-31$38,614
Value of certain deemed distributions of participant loans2021-12-31$1,375
Value of corrective distributions2021-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$9,774
2020 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2020 401k financial data
Transfers to/from the plan2020-12-31$204,753
Total plan liabilities at end of year2020-12-31$39,720
Total plan liabilities at beginning of year2020-12-31$231,987
Total income from all sources2020-12-31$143,106
Expenses. Total of all expenses incurred2020-12-31$52,144
Benefits paid (including direct rollovers)2020-12-31$39,720
Total plan assets at end of year2020-12-31$1,050,732
Total plan assets at beginning of year2020-12-31$947,284
Total contributions received or receivable from participants2020-12-31$13,660
Expenses. Other expenses not covered elsewhere2020-12-31$681
Contributions received from other sources (not participants or employers)2020-12-31$0
Other income received2020-12-31$88,366
Noncash contributions received2020-12-31$0
Net income (gross income less expenses)2020-12-31$90,962
Net plan assets at end of year (total assets less liabilities)2020-12-31$1,011,012
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$715,297
Assets. Value of participant loans2020-12-31$8,221
Total contributions received or receivable from employer(s)2020-12-31$41,080
Value of certain deemed distributions of participant loans2020-12-31$1,950
Value of corrective distributions2020-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$9,793
2019 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2019 401k financial data
Transfers to/from the plan2019-12-31$-52,389
Total plan liabilities at end of year2019-12-31$231,987
Total plan liabilities at beginning of year2019-12-31$49,155
Total income from all sources2019-12-31$68,073
Expenses. Total of all expenses incurred2019-12-31$262,798
Benefits paid (including direct rollovers)2019-12-31$231,987
Total plan assets at end of year2019-12-31$947,284
Total plan assets at beginning of year2019-12-31$1,011,566
Total contributions received or receivable from participants2019-12-31$13,250
Expenses. Other expenses not covered elsewhere2019-12-31$15,244
Other income received2019-12-31$10,460
Net income (gross income less expenses)2019-12-31$-194,725
Net plan assets at end of year (total assets less liabilities)2019-12-31$715,297
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$962,411
Assets. Value of participant loans2019-12-31$17,288
Total contributions received or receivable from employer(s)2019-12-31$44,363
Value of certain deemed distributions of participant loans2019-12-31$1,471
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$14,096
2018 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2018 401k financial data
Transfers to/from the plan2018-12-31$-79,585
Total plan liabilities at end of year2018-12-31$49,155
Total plan liabilities at beginning of year2018-12-31$18,745
Total income from all sources2018-12-31$26,802
Expenses. Total of all expenses incurred2018-12-31$81,281
Benefits paid (including direct rollovers)2018-12-31$67,900
Total plan assets at end of year2018-12-31$1,011,566
Total plan assets at beginning of year2018-12-31$1,115,220
Total contributions received or receivable from participants2018-12-31$25,599
Expenses. Other expenses not covered elsewhere2018-12-31$199
Other income received2018-12-31$-49,969
Net income (gross income less expenses)2018-12-31$-54,479
Net plan assets at end of year (total assets less liabilities)2018-12-31$962,411
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$1,096,475
Assets. Value of participant loans2018-12-31$10,001
Total contributions received or receivable from employer(s)2018-12-31$51,172
Value of certain deemed distributions of participant loans2018-12-31$519
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$12,663
2017 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$18,745
Total plan liabilities at beginning of year2017-12-31$12,551
Total income from all sources2017-12-31$186,966
Expenses. Total of all expenses incurred2017-12-31$33,176
Benefits paid (including direct rollovers)2017-12-31$18,745
Total plan assets at end of year2017-12-31$1,115,220
Total plan assets at beginning of year2017-12-31$955,236
Total contributions received or receivable from participants2017-12-31$25,224
Other income received2017-12-31$110,455
Net income (gross income less expenses)2017-12-31$153,790
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,096,475
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$942,685
Assets. Value of participant loans2017-12-31$12,231
Total contributions received or receivable from employer(s)2017-12-31$51,287
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$14,431
2016 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2016 401k financial data
Transfers to/from the plan2016-12-31$-7,591
Total plan liabilities at end of year2016-12-31$12,551
Total income from all sources2016-12-31$120,133
Expenses. Total of all expenses incurred2016-12-31$26,995
Benefits paid (including direct rollovers)2016-12-31$14,128
Total plan assets at end of year2016-12-31$955,233
Total plan assets at beginning of year2016-12-31$857,135
Total contributions received or receivable from participants2016-12-31$24,588
Expenses. Other expenses not covered elsewhere2016-12-31$1,329
Other income received2016-12-31$47,081
Net income (gross income less expenses)2016-12-31$93,138
Net plan assets at end of year (total assets less liabilities)2016-12-31$942,682
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$857,135
Assets. Value of participant loans2016-12-31$7,354
Total contributions received or receivable from employer(s)2016-12-31$48,464
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$11,538
2015 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2015 401k financial data
Total income from all sources2015-12-31$72,137
Expenses. Total of all expenses incurred2015-12-31$17,487
Total plan assets at end of year2015-12-31$857,133
Total plan assets at beginning of year2015-12-31$802,483
Total contributions received or receivable from participants2015-12-31$28,313
Expenses. Other expenses not covered elsewhere2015-12-31$1,595
Other income received2015-12-31$-8,931
Net income (gross income less expenses)2015-12-31$54,650
Net plan assets at end of year (total assets less liabilities)2015-12-31$857,133
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$802,483
Assets. Value of participant loans2015-12-31$11,798
Total contributions received or receivable from employer(s)2015-12-31$52,755
Value of certain deemed distributions of participant loans2015-12-31$5,761
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$10,131
2014 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$-74,851
Total income from all sources2014-12-31$124,946
Expenses. Total of all expenses incurred2014-12-31$134,032
Benefits paid (including direct rollovers)2014-12-31$110,907
Total plan assets at end of year2014-12-31$802,483
Total plan assets at beginning of year2014-12-31$886,420
Total contributions received or receivable from participants2014-12-31$22,210
Expenses. Other expenses not covered elsewhere2014-12-31$674
Other income received2014-12-31$49,604
Net income (gross income less expenses)2014-12-31$-9,086
Net plan assets at end of year (total assets less liabilities)2014-12-31$802,483
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$886,420
Assets. Value of participant loans2014-12-31$19,367
Total contributions received or receivable from employer(s)2014-12-31$53,132
Value of certain deemed distributions of participant loans2014-12-31$12,934
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$9,517
2013 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$-59,379
Total plan liabilities at end of year2013-12-31$53,247
Total plan liabilities at beginning of year2013-12-31$35,400
Total income from all sources2013-12-31$146,819
Expenses. Total of all expenses incurred2013-12-31$24,040
Total plan assets at end of year2013-12-31$477,102
Total plan assets at beginning of year2013-12-31$395,855
Total contributions received or receivable from participants2013-12-31$33,630
Expenses. Other expenses not covered elsewhere2013-12-31$663
Other income received2013-12-31$60,855
Net income (gross income less expenses)2013-12-31$122,779
Net plan assets at end of year (total assets less liabilities)2013-12-31$423,855
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$360,455
Assets. Value of participant loans2013-12-31$19,025
Total contributions received or receivable from employer(s)2013-12-31$52,334
Value of certain deemed distributions of participant loans2013-12-31$12,444
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$10,933
2012 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$-4,357
Total plan liabilities at end of year2012-12-31$35,400
Total plan liabilities at beginning of year2012-12-31$96,045
Total income from all sources2012-12-31$142,227
Expenses. Total of all expenses incurred2012-12-31$16,871
Total plan assets at end of year2012-12-31$395,855
Total plan assets at beginning of year2012-12-31$356,217
Total contributions received or receivable from participants2012-12-31$22,763
Expenses. Other expenses not covered elsewhere2012-12-31$612
Other income received2012-12-31$66,439
Net income (gross income less expenses)2012-12-31$125,356
Net plan assets at end of year (total assets less liabilities)2012-12-31$360,455
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$260,172
Assets. Value of participant loans2012-12-31$26,419
Total contributions received or receivable from employer(s)2012-12-31$53,025
Value of certain deemed distributions of participant loans2012-12-31$6,659
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$9,600
2011 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$-38,547
Total plan liabilities at end of year2011-12-31$96,045
Total plan liabilities at beginning of year2011-12-31$15,971
Total income from all sources2011-12-31$72,791
Expenses. Total of all expenses incurred2011-12-31$9,486
Total plan assets at end of year2011-12-31$356,217
Total plan assets at beginning of year2011-12-31$339,476
Total contributions received or receivable from participants2011-12-31$18,513
Expenses. Other expenses not covered elsewhere2011-12-31$732
Other income received2011-12-31$3,791
Net income (gross income less expenses)2011-12-31$63,305
Net plan assets at end of year (total assets less liabilities)2011-12-31$260,172
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$323,505
Assets. Value of participant loans2011-12-31$18,371
Total contributions received or receivable from employer(s)2011-12-31$50,487
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$8,754
2010 : LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2010 401k financial data
Total income from all sources2010-12-31$82,886
Expenses. Total of all expenses incurred2010-12-31$21,588
Total plan assets at end of year2010-12-31$334,835
Total plan assets at beginning of year2010-12-31$273,537
Total contributions received or receivable from participants2010-12-31$19,298
Expenses. Other expenses not covered elsewhere2010-12-31$21,588
Other income received2010-12-31$12,385
Net income (gross income less expenses)2010-12-31$61,298
Net plan assets at end of year (total assets less liabilities)2010-12-31$334,835
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$273,537
Assets. Value of participant loans2010-12-31$4,641
Total contributions received or receivable from employer(s)2010-12-31$51,203

Form 5500 Responses for LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN

2022: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: LAKE COUNTRY AREA AGENCY ON AGING, INC. TSA PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement - TrustYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number014146
Policy instance 1
Insurance contract or identification number014146
Number of Individuals Covered55
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,279
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $1,192
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNA
Insurance broker organization code?3
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number014146
Policy instance 1
Insurance contract or identification number014146
Number of Individuals Covered50
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,308
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $1,256
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNA
Insurance broker organization code?3
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number51162944
Policy instance 1
Insurance contract or identification number51162944
Number of Individuals Covered56
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,570
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $12
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNA
Insurance broker organization code?3
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number51162944
Policy instance 1
Insurance contract or identification number51162944
Number of Individuals Covered54
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,702
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $14
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerNA
Insurance broker organization code?3
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number511-62944
Policy instance 1
Insurance contract or identification number511-62944
Number of Individuals Covered57
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,427
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 BrokerUSD $3,896
Additional information about fees paid to insurance brokerN/A N/A
Insurance broker organization code?3
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number511-62944
Policy instance 1
Insurance contract or identification number511-62944
Number of Individuals Covered57
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,351
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 BrokerUSD $2,351
Additional information about fees paid to insurance brokerN/A N/A
Insurance broker organization code?3
Insurance broker nameJ. JACOBS
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number511-62944
Policy instance 1
Insurance contract or identification number511-62944
Number of Individuals Covered52
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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 number511-62944
Policy instance 1
Insurance contract or identification number511-62944
Number of Individuals Covered55
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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

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