TRI STATE CAPITAL LIFE AND DISABILITY PLAN 401k Plan overview

TRI STATE CAPITAL LIFE AND DISABILITY PLAN Benefits

401k Sponsoring company profile

Company Name:	TRI STATE CAPITAL BANK
Employer identification number (EIN):	205888359
NAIC Classification:	522110
NAIC Description:	Commercial Banking

Form 5500 Filing Information

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2016-01-01	THAD CLEMENTS
502	2016-01-01	THAD CLEMENTS
502	2015-01-01	THAD CLEMENTS
502	2014-01-01	THAD CLEMENTS
502	2013-01-01	THAD CLEMENTS
502	2012-01-01	THAD CLEMENTS

Plan Statistics for TRI STATE CAPITAL LIFE AND DISABILITY PLAN

Measure	Date	Value
2016: TRI STATE CAPITAL LIFE AND DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	155
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	155
2015: TRI STATE CAPITAL LIFE AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	137
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	137
2014: TRI STATE CAPITAL LIFE AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	135
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	135
2013: TRI STATE CAPITAL LIFE AND DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	128
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	128
2012: TRI STATE CAPITAL LIFE AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	118
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	118

Form 5500 Responses for TRI STATE CAPITAL LIFE AND DISABILITY PLAN

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