| Plan Name | TRI STATE CAPITAL DENTAL PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | TRI STATE CAPITAL BANK |
| Employer identification number (EIN): | 205888359 |
| NAIC Classification: | 522110 |
| NAIC Description: | Commercial Banking |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2016-01-01 | THAD CLEMENTS | |||
| 503 | 2016-01-01 | THAD CLEMENTS | |||
| 503 | 2015-01-01 | THAD CLEMENTS | |||
| 503 | 2014-01-01 | THAD CLEMENTS | |||
| 503 | 2013-01-01 | THAD CLEMENTS | |||
| 503 | 2012-01-01 | THAD CLEMENTS |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 0772680 |
| Policy instance | 1 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) | |
| Policy contract number | 852258-000 |
| Policy instance | 1 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) | |
| Policy contract number | 852258-000 |
| Policy instance | 1 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) | |
| Policy contract number | 852258-000 |
| Policy instance | 1 |