401k Plan data: JERSEY SHORE STATE BANK GROUP HEALTH PLAN plan

JERSEY SHORE STATE BANK GROUP HEALTH PLAN 401k Plan overview

Plan Name	JERSEY SHORE STATE BANK GROUP HEALTH PLAN
Plan identification number	501

JERSEY SHORE STATE BANK GROUP HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

JERSEY SHORE STATE BANK has sponsored the creation of one or more 401k plans.

Company Name: JERSEY SHORE STATE BANK

Employer identification number (EIN): 240622580

NAIC Classification: 522110
NAIC Description: Commercial Banking

Additional information about JERSEY SHORE STATE BANK

Jurisdiction of Incorporation: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE

Incorporation Date:

Company Identification Number: 179376

More information about JERSEY SHORE STATE BANK

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JERSEY SHORE STATE BANK GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 KELLY AMOS
501 2015-01-01 KELLY AMOS
501 2014-01-01 KELLY AMOS
501 2014-01-01 JOANN DIPASQUALE
501 2013-01-01 JOANN DIPASQUALE
501 2012-01-01 JOANN DIPASQUALE
501 2011-01-01 JOANN DIPASQUALE
501 2009-01-01 JOANN DIPASQUALE
501 2009-01-01 JOANN DIPASQUALE

Plan id#	Filing Submission Date	Name of Administrator
501	2015-01-01	KELLY AMOS
501	2015-01-01	KELLY AMOS
501	2014-01-01	KELLY AMOS
501	2014-01-01	JOANN DIPASQUALE
501	2013-01-01	JOANN DIPASQUALE
501	2012-01-01	JOANN DIPASQUALE
501	2011-01-01	JOANN DIPASQUALE
501	2009-01-01	JOANN DIPASQUALE
501	2009-01-01	JOANN DIPASQUALE

Plan Statistics for JERSEY SHORE STATE BANK GROUP HEALTH PLAN

401k plan membership statisitcs for JERSEY SHORE STATE BANK GROUP HEALTH PLAN

Measure Date Value
2015: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 142
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 2015-01-01 142
2014: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 120
Number of retired or separated participants receiving benefits 2014-01-01 3
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 123
2013: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 130
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 2013-01-01 130
2012: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 115
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 116
2011: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 119
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 119
2009: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 120
Number of retired or separated participants receiving benefits 2009-01-01 5
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 125

Measure	Date	Value
2015: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	142
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	142
2014: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	120
Number of retired or separated participants receiving benefits	2014-01-01	3
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	123
2013: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	130
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	130
2012: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	115
Number of retired or separated participants receiving benefits	2012-01-01	1
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	116
2011: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	119
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	119
2009: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	120
Number of retired or separated participants receiving benefits	2009-01-01	5
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	125

Financial Data on JERSEY SHORE STATE BANK GROUP HEALTH PLAN

Measure	Date	Value
2015 : JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$147,151
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$3,346
Total income from all sources (including contributions)	2015-12-31	$1,786,105
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$1,680,597
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$1,211,204
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,784,790
Value of total assets at end of year	2015-12-31	$516,942
Value of total assets at beginning of year	2015-12-31	$267,629
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$469,393
Total interest from all sources	2015-12-31	$1,315
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$1,438,557
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$346,233
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$146,899
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$327,470
Total non interest bearing cash at end of year	2015-12-31	$46,790
Total non interest bearing cash at beginning of year	2015-12-31	$3,346
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$105,508
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$369,791
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$264,283
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Investment advisory and management fees	2015-12-31	$47,008
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$470,152
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$264,283
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$264,283
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$1,315
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$1,211,204
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contract administrator fees	2015-12-31	$94,915
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$252
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$3,346
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN	2015-12-31	251589048
2014 : JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$3,346
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$12,690
Total income from all sources (including contributions)	2014-12-31	$1,387,247
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$1,456,992
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$1,051,625
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,386,336
Value of total assets at end of year	2014-12-31	$267,629
Value of total assets at beginning of year	2014-12-31	$346,718
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$405,367
Total interest from all sources	2014-12-31	$911
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$477,929
Administrative expenses (other) incurred	2014-12-31	$272,873
Total non interest bearing cash at end of year	2014-12-31	$3,346
Total non interest bearing cash at beginning of year	2014-12-31	$683
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-69,745
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$264,283
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$334,028
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Investment advisory and management fees	2014-12-31	$42,544
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$264,283
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$346,035
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$346,035
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$911
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$1,051,625
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$908,407
Contract administrator fees	2014-12-31	$89,950
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$3,346
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$12,690
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN	2014-12-31	251589048
2013 : JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$12,690
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$10,597
Total income from all sources (including contributions)	2013-12-31	$1,424,399
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$1,692,078
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,306,249
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,255,648
Value of total assets at end of year	2013-12-31	$346,718
Value of total assets at beginning of year	2013-12-31	$612,304
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$385,829
Total interest from all sources	2013-12-31	$1,567
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$274,180
Other income not declared elsewhere	2013-12-31	$167,184
Administrative expenses (other) incurred	2013-12-31	$260,855
Total non interest bearing cash at end of year	2013-12-31	$683
Total non interest bearing cash at beginning of year	2013-12-31	$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	2013-12-31	No
Value of net income/loss	2013-12-31	$-267,679
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$334,028
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$601,707
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Investment advisory and management fees	2013-12-31	$39,693
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$346,035
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$612,304
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$612,304
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$1,567
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$981,468
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,306,249
Contract administrator fees	2013-12-31	$85,281
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$12,690
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$10,597
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN	2013-12-31	251589048
2012 : JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$10,597
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$136,744
Total income from all sources (including contributions)	2012-12-31	$1,481,989
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$1,068,200
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$719,123
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,473,684
Value of total assets at end of year	2012-12-31	$612,304
Value of total assets at beginning of year	2012-12-31	$324,662
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$349,077
Total interest from all sources	2012-12-31	$2,419
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$253,754
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$129,163
Other income not declared elsewhere	2012-12-31	$5,886
Administrative expenses (other) incurred	2012-12-31	$228,245
Total non interest bearing cash at end of year	2012-12-31	$0
Total non interest bearing cash at beginning of year	2012-12-31	$36,139
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$413,789
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$601,707
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$187,918
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Investment advisory and management fees	2012-12-31	$37,678
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$612,304
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$288,523
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$288,523
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$2,419
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$1,219,930
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$719,123
Contract administrator fees	2012-12-31	$83,154
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$10,597
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$7,581
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN	2012-12-31	251589048
2011 : JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$136,744
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$1,415,820
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$1,252,520
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$919,185
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$1,238,149
Value of total assets at end of year	2011-12-31	$324,662
Value of total assets at beginning of year	2011-12-31	$24,618
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$333,335
Total interest from all sources	2011-12-31	$1,475
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$223,368
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$129,163
Other income not declared elsewhere	2011-12-31	$176,196
Administrative expenses (other) incurred	2011-12-31	$216,937
Total non interest bearing cash at end of year	2011-12-31	$36,139
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$163,300
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$187,918
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$24,618
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Investment advisory and management fees	2011-12-31	$35,833
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$288,523
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$24,618
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$24,618
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$1,475
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$1,014,781
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$919,185
Contract administrator fees	2011-12-31	$80,565
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$7,581
Did the plan have assets held for investment	2011-12-31	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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN	2011-12-31	251589048
2010 : JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$101,917
Total income from all sources (including contributions)	2010-12-31	$1,267,929
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$1,364,201
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$1,248,993
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,186,338
Value of total assets at end of year	2010-12-31	$24,618
Value of total assets at beginning of year	2010-12-31	$222,807
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$115,208
Total interest from all sources	2010-12-31	$1,724
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$1,555,810
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$201,352
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$1,248,993
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$101,917
Other income not declared elsewhere	2010-12-31	$79,867
Total non interest bearing cash at beginning of year	2010-12-31	$30,685
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-96,272
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$24,618
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$120,890
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Investment advisory and management fees	2010-12-31	$37,401
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$24,618
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$192,122
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$192,122
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$1,724
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$984,986
Contract administrator fees	2010-12-31	$77,807
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	YOUNG, OAKES, BROWN & CO., P.C.
Accountancy firm EIN	2010-12-31	251589048

Form 5500 Responses for JERSEY SHORE STATE BANK GROUP HEALTH PLAN

2015: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
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 – Trust	Yes
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: JERSEY SHORE STATE BANK GROUP HEALTH PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 )

Policy contract number

40618

Policy instance

Insurance contract or identification number	40618
Number of Individuals Covered	168
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,793
Total amount of fees paid to insurance company	USD $0
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 contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $51,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 )

Policy contract number

40618

Policy instance

Insurance contract or identification number	40618
Number of Individuals Covered	172
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,643
Total amount of fees paid to insurance company	USD $0
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 contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $47,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SECURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68721 )

Policy contract number

40618

Policy instance

Insurance contract or identification number	40618
Number of Individuals Covered	152
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,607
Total amount of fees paid to insurance company	USD $0
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 contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $21,307

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Company Name:	JERSEY SHORE STATE BANK
Employer identification number (EIN):	240622580
NAIC Classification:	522110
NAIC Description:	Commercial Banking

Jurisdiction of Incorporation:	COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE
Incorporation Date:
Company Identification Number:	179376