401k Plan data: FIRST STATE BANK 401(K) PROFIT SHARING PLAN plan

FIRST STATE BANK 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	FIRST STATE BANK 401(K) PROFIT SHARING PLAN
Plan identification number	001

FIRST STATE BANK 401(K) PROFIT SHARING 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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

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

Company Name: FIRST STATE BANK

Employer identification number (EIN): 361465165

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST STATE BANK 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 DEBORAH ROGERS 2023-10-04 TIMOTHY MCCONVILLE 2023-10-05
001 2021-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 DEBORAH ROGERS TIM MCCONVILLE 2018-08-14
001 2016-01-01 DEBORAH ROGERS TIM MCCONVILLE 2017-09-25
001 2015-01-01 DEBORAH ROGERS TIM MCCONVILLE 2016-10-13
001 2014-01-01 DEBORAH ROGERS TIM MCCONVILLE 2015-07-17
001 2013-01-01 DEBORAH ROGERS TIM MCCONVILLE 2014-07-31
001 2012-01-01 DEBORAH ROGERS 2013-04-03 TIM MCCONVILLE 2013-04-03
001 2011-01-01 DEBORAH ROGERS 2012-05-08 TIMOTHY MCCONVILLE 2012-05-10
001 2010-01-01 TIMOTHY MCCONVILLE 2011-09-13 TIMOTHY MCCONVILLE 2011-09-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	DEBORAH ROGERS	2023-10-04	TIMOTHY MCCONVILLE	2023-10-05
001	2021-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	DEBORAH ROGERS		TIM MCCONVILLE	2018-08-14
001	2016-01-01	DEBORAH ROGERS		TIM MCCONVILLE	2017-09-25
001	2015-01-01	DEBORAH ROGERS		TIM MCCONVILLE	2016-10-13
001	2014-01-01	DEBORAH ROGERS		TIM MCCONVILLE	2015-07-17
001	2013-01-01	DEBORAH ROGERS		TIM MCCONVILLE	2014-07-31
001	2012-01-01	DEBORAH ROGERS	2013-04-03	TIM MCCONVILLE	2013-04-03
001	2011-01-01	DEBORAH ROGERS	2012-05-08	TIMOTHY MCCONVILLE	2012-05-10
001	2010-01-01	TIMOTHY MCCONVILLE	2011-09-13	TIMOTHY MCCONVILLE	2011-09-13

Plan Statistics for FIRST STATE BANK 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for FIRST STATE BANK 401(K) PROFIT SHARING PLAN

Measure Date Value
2022: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 266
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 195
Number of retired or separated participants receiving benefits 2022-01-01 1
Number of other retired or separated participants entitled to future benefits 2022-01-01 61
Total of all active and inactive participants 2022-01-01 257
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 257
Number of participants with account balances 2022-01-01 253
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 267
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 193
Number of retired or separated participants receiving benefits 2021-01-01 1
Number of other retired or separated participants entitled to future benefits 2021-01-01 58
Total of all active and inactive participants 2021-01-01 252
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 252
Number of participants with account balances 2021-01-01 250
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 243
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 195
Number of retired or separated participants receiving benefits 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 59
Total of all active and inactive participants 2020-01-01 255
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 255
Number of participants with account balances 2020-01-01 255
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 232
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 180
Number of retired or separated participants receiving benefits 2019-01-01 8
Number of other retired or separated participants entitled to future benefits 2019-01-01 45
Total of all active and inactive participants 2019-01-01 233
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 233
Number of participants with account balances 2019-01-01 233
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 228
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 186
Number of retired or separated participants receiving benefits 2018-01-01 10
Number of other retired or separated participants entitled to future benefits 2018-01-01 44
Total of all active and inactive participants 2018-01-01 240
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 240
Number of participants with account balances 2018-01-01 240
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 231
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 187
Number of retired or separated participants receiving benefits 2017-01-01 2
Number of other retired or separated participants entitled to future benefits 2017-01-01 32
Total of all active and inactive participants 2017-01-01 221
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 1
Total participants 2017-01-01 222
Number of participants with account balances 2017-01-01 222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 228
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 188
Number of retired or separated participants receiving benefits 2016-01-01 7
Number of other retired or separated participants entitled to future benefits 2016-01-01 32
Total of all active and inactive participants 2016-01-01 227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 227
Number of participants with account balances 2016-01-01 227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 222
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 195
Number of retired or separated participants receiving benefits 2015-01-01 6
Number of other retired or separated participants entitled to future benefits 2015-01-01 21
Total of all active and inactive participants 2015-01-01 222
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 222
Number of participants with account balances 2015-01-01 222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 210
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 190
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 23
Total of all active and inactive participants 2014-01-01 214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 214
Number of participants with account balances 2014-01-01 208
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 176
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 16
Total of all active and inactive participants 2013-01-01 192
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 192
Number of participants with account balances 2013-01-01 179
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2022: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	266
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	195
Number of retired or separated participants receiving benefits	2022-01-01	1
Number of other retired or separated participants entitled to future benefits	2022-01-01	61
Total of all active and inactive participants	2022-01-01	257
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	257
Number of participants with account balances	2022-01-01	253
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	267
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	193
Number of retired or separated participants receiving benefits	2021-01-01	1
Number of other retired or separated participants entitled to future benefits	2021-01-01	58
Total of all active and inactive participants	2021-01-01	252
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	252
Number of participants with account balances	2021-01-01	250
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	243
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	195
Number of retired or separated participants receiving benefits	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	59
Total of all active and inactive participants	2020-01-01	255
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	255
Number of participants with account balances	2020-01-01	255
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	232
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	180
Number of retired or separated participants receiving benefits	2019-01-01	8
Number of other retired or separated participants entitled to future benefits	2019-01-01	45
Total of all active and inactive participants	2019-01-01	233
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	233
Number of participants with account balances	2019-01-01	233
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	228
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	186
Number of retired or separated participants receiving benefits	2018-01-01	10
Number of other retired or separated participants entitled to future benefits	2018-01-01	44
Total of all active and inactive participants	2018-01-01	240
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	240
Number of participants with account balances	2018-01-01	240
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	231
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	187
Number of retired or separated participants receiving benefits	2017-01-01	2
Number of other retired or separated participants entitled to future benefits	2017-01-01	32
Total of all active and inactive participants	2017-01-01	221
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	1
Total participants	2017-01-01	222
Number of participants with account balances	2017-01-01	222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	228
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	188
Number of retired or separated participants receiving benefits	2016-01-01	7
Number of other retired or separated participants entitled to future benefits	2016-01-01	32
Total of all active and inactive participants	2016-01-01	227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	227
Number of participants with account balances	2016-01-01	227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	222
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	195
Number of retired or separated participants receiving benefits	2015-01-01	6
Number of other retired or separated participants entitled to future benefits	2015-01-01	21
Total of all active and inactive participants	2015-01-01	222
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	222
Number of participants with account balances	2015-01-01	222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	210
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	190
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	23
Total of all active and inactive participants	2014-01-01	214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	214
Number of participants with account balances	2014-01-01	208
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	176
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	16
Total of all active and inactive participants	2013-01-01	192
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	192
Number of participants with account balances	2013-01-01	179
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Financial Data on FIRST STATE BANK 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2022 : FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-3,380,516
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$2,231,794
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$2,100,002
Expenses. Certain deemed distributions of participant loans	2022-12-31	$6,566
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$2,645,071
Value of total assets at end of year	2022-12-31	$30,482,083
Value of total assets at beginning of year	2022-12-31	$36,094,393
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$125,226
Total interest from all sources	2022-12-31	$5,504
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$4,000,000
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	$1,143,007
Participant contributions at end of year	2022-12-31	$162,696
Participant contributions at beginning of year	2022-12-31	$115,289
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$226,653
Administrative expenses (other) incurred	2022-12-31	$1,350
Total non interest bearing cash at end of year	2022-12-31	$196
Total non interest bearing cash at beginning of year	2022-12-31	$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	2022-12-31	No
Value of net income/loss	2022-12-31	$-5,612,310
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$30,482,083
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$36,094,393
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
Investment advisory and management fees	2022-12-31	$46,266
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$29,673,355
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$35,257,734
Interest on participant loans	2022-12-31	$5,504
Net investment gain/loss from pooled separate accounts	2022-12-31	$-6,031,091
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	$1,275,411
Employer contributions (assets) at end of year	2022-12-31	$645,836
Employer contributions (assets) at beginning of year	2022-12-31	$721,370
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$2,100,002
Contract administrator fees	2022-12-31	$77,610
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	WIPFLI LLP
Accountancy firm EIN	2022-12-31	390758449
2021 : FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$6,893,451
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$3,306,600
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$3,130,674
Expenses. Certain deemed distributions of participant loans	2021-12-31	$35,525
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$2,529,487
Value of total assets at end of year	2021-12-31	$36,094,393
Value of total assets at beginning of year	2021-12-31	$32,507,542
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$140,401
Total interest from all sources	2021-12-31	$5,607
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$1,062,768
Participant contributions at end of year	2021-12-31	$115,289
Participant contributions at beginning of year	2021-12-31	$128,268
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$128,231
Administrative expenses (other) incurred	2021-12-31	$599
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	$3,586,851
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$36,094,393
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$32,507,542
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	$51,103
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$35,257,734
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$31,621,607
Interest on participant loans	2021-12-31	$5,607
Net investment gain/loss from pooled separate accounts	2021-12-31	$4,358,357
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	$1,338,488
Employer contributions (assets) at end of year	2021-12-31	$721,370
Employer contributions (assets) at beginning of year	2021-12-31	$757,667
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$3,130,674
Contract administrator fees	2021-12-31	$88,699
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	Disclaimer
Accountancy firm name	2021-12-31	WIPFLI LLP
Accountancy firm EIN	2021-12-31	390758449
2020 : FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total transfer of assets to this plan	2020-12-31	$1,271,068
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
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	$7,144,811
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$559,978
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$505,423
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$2,374,332
Value of total assets at end of year	2020-12-31	$32,507,542
Value of total assets at beginning of year	2020-12-31	$24,651,641
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$54,555
Total interest from all sources	2020-12-31	$5,382
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$1,018,642
Participant contributions at end of year	2020-12-31	$128,268
Participant contributions at beginning of year	2020-12-31	$101,559
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$6,825
Administrative expenses (other) incurred	2020-12-31	$1,049
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	$6,584,833
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$32,507,542
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$24,651,641
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	$52,817
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$31,621,607
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$24,164,832
Income. Interest from loans (other than to participants)	2020-12-31	$5,382
Net investment gain/loss from pooled separate accounts	2020-12-31	$4,765,097
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	$1,348,865
Employer contributions (assets) at end of year	2020-12-31	$757,667
Employer contributions (assets) at beginning of year	2020-12-31	$385,250
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$505,423
Contract administrator fees	2020-12-31	$689
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
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	WIPFLI LLP
Accountancy firm EIN	2020-12-31	390758449
2019 : FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	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 liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning 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	$6,305,770
Total income from all sources (including contributions)	2019-12-31	$6,305,770
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$2,111,549
Total of all expenses incurred	2019-12-31	$2,111,549
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$2,065,271
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$2,065,271
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,869,155
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,869,155
Value of total assets at end of year	2019-12-31	$24,651,641
Value of total assets at end of year	2019-12-31	$24,651,641
Value of total assets at beginning of year	2019-12-31	$20,457,420
Value of total assets at beginning of year	2019-12-31	$20,457,420
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$46,278
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$46,278
Total interest from all sources	2019-12-31	$3,516
Total interest from all sources	2019-12-31	$3,516
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
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	$3,000,000
Value of fidelity bond cover	2019-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
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	$919,164
Contributions received from participants	2019-12-31	$919,164
Participant contributions at end of year	2019-12-31	$101,559
Participant contributions at end of year	2019-12-31	$101,559
Participant contributions at beginning of year	2019-12-31	$74,722
Participant contributions at beginning of year	2019-12-31	$74,722
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$33,956
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$33,956
Administrative expenses (other) incurred	2019-12-31	$450
Administrative expenses (other) incurred	2019-12-31	$450
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	$4,194,221
Value of net income/loss	2019-12-31	$4,194,221
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$24,651,641
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$24,651,641
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$20,457,420
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$20,457,420
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
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	$45,057
Investment advisory and management fees	2019-12-31	$45,057
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$24,164,832
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$24,164,832
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$20,001,265
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$20,001,265
Interest on participant loans	2019-12-31	$3,516
Interest on participant loans	2019-12-31	$3,516
Net investment gain/loss from pooled separate accounts	2019-12-31	$4,433,099
Net investment gain/loss from pooled separate accounts	2019-12-31	$4,433,099
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	$916,035
Contributions received in cash from employer	2019-12-31	$916,035
Employer contributions (assets) at end of year	2019-12-31	$385,250
Employer contributions (assets) at end of year	2019-12-31	$385,250
Employer contributions (assets) at beginning of year	2019-12-31	$381,433
Employer contributions (assets) at beginning of year	2019-12-31	$381,433
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$2,065,271
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$2,065,271
Contract administrator fees	2019-12-31	$771
Contract administrator fees	2019-12-31	$771
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
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	WIPFLI LLP
Accountancy firm name	2019-12-31	WIPFLI LLP
Accountancy firm EIN	2019-12-31	390758449
Accountancy firm EIN	2019-12-31	390758449
2018 : FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$514,746
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,704,991
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,637,283
Expenses. Certain deemed distributions of participant loans	2018-12-31	$11,655
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,786,156
Value of total assets at end of year	2018-12-31	$20,457,420
Value of total assets at beginning of year	2018-12-31	$21,647,665
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$56,053
Total interest from all sources	2018-12-31	$3,850
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$895,531
Participant contributions at end of year	2018-12-31	$74,722
Participant contributions at beginning of year	2018-12-31	$95,480
Administrative expenses (other) incurred	2018-12-31	$450
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-1,190,245
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$20,457,420
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$21,647,665
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$21,468
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$20,001,265
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$21,278,853
Interest on participant loans	2018-12-31	$3,850
Net investment gain/loss from pooled separate accounts	2018-12-31	$-1,275,260
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$890,625
Employer contributions (assets) at end of year	2018-12-31	$381,433
Employer contributions (assets) at beginning of year	2018-12-31	$273,332
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,637,283
Contract administrator fees	2018-12-31	$34,135
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	WIPFLI LLP
Accountancy firm EIN	2018-12-31	390758449
2017 : FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$4,670,530
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$405,273
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$342,379
Expenses. Certain deemed distributions of participant loans	2017-12-31	$2,867
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,605,593
Value of total assets at end of year	2017-12-31	$21,647,665
Value of total assets at beginning of year	2017-12-31	$17,382,408
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$60,027
Total interest from all sources	2017-12-31	$3,921
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$837,920
Participant contributions at end of year	2017-12-31	$95,480
Participant contributions at beginning of year	2017-12-31	$91,627
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$9,654
Administrative expenses (other) incurred	2017-12-31	$750
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$4,265,257
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$21,647,665
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$17,382,408
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$21,278,853
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$17,008,653
Interest on participant loans	2017-12-31	$3,921
Net investment gain/loss from pooled separate accounts	2017-12-31	$3,061,016
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$758,019
Employer contributions (assets) at end of year	2017-12-31	$273,332
Employer contributions (assets) at beginning of year	2017-12-31	$282,128
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$342,379
Contract administrator fees	2017-12-31	$59,277
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	WIPFLI LLP
Accountancy firm EIN	2017-12-31	390758449
2016 : FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$2,694,777
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$661,017
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$611,220
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,543,536
Value of total assets at end of year	2016-12-31	$17,382,408
Value of total assets at beginning of year	2016-12-31	$15,348,648
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$49,797
Total interest from all sources	2016-12-31	$1,746
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$773,563
Participant contributions at end of year	2016-12-31	$91,627
Participant contributions at beginning of year	2016-12-31	$22,119
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$23,294
Administrative expenses (other) incurred	2016-12-31	$1,300
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$2,033,760
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$17,382,408
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$15,348,648
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$17,008,653
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$15,154,580
Income. Interest from loans (other than to participants)	2016-12-31	$1,746
Net investment gain/loss from pooled separate accounts	2016-12-31	$1,149,495
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$746,679
Employer contributions (assets) at end of year	2016-12-31	$282,128
Employer contributions (assets) at beginning of year	2016-12-31	$171,949
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$611,220
Contract administrator fees	2016-12-31	$48,497
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	WIPFLI LLP
Accountancy firm EIN	2016-12-31	390758449
2015 : FIRST STATE BANK 401(K) PROFIT SHARING 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$1,228,279
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$495,879
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$447,740
Expenses. Certain deemed distributions of participant loans	2015-12-31	$2,005
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,397,420
Value of total assets at end of year	2015-12-31	$15,348,648
Value of total assets at beginning of year	2015-12-31	$14,616,248
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$46,134
Total interest from all sources	2015-12-31	$1,159
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	$3,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$751,438
Participant contributions at end of year	2015-12-31	$22,119
Participant contributions at beginning of year	2015-12-31	$38,052
Administrative expenses (other) incurred	2015-12-31	$300
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
Income. Non cash contributions	2015-12-31	$1,741
Value of net income/loss	2015-12-31	$732,400
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$15,348,648
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$14,616,248
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$15,154,580
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$14,425,312
Interest on participant loans	2015-12-31	$1,159
Net investment gain/loss from pooled separate accounts	2015-12-31	$-170,300
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
Contributions received in cash from employer	2015-12-31	$644,241
Employer contributions (assets) at end of year	2015-12-31	$171,949
Employer contributions (assets) at beginning of year	2015-12-31	$152,884
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$447,740
Contract administrator fees	2015-12-31	$45,834
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	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	WIPFLI LLP
Accountancy firm EIN	2015-12-31	390758449
2014 : FIRST STATE BANK 401(K) PROFIT SHARING 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$2,109,632
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$532,512
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$504,299
Expenses. Certain deemed distributions of participant loans	2014-12-31	$2,355
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,424,296
Value of total assets at end of year	2014-12-31	$14,616,248
Value of total assets at beginning of year	2014-12-31	$13,039,128
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$25,858
Total interest from all sources	2014-12-31	$1,630
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
Administrative expenses professional fees incurred	2014-12-31	$450
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$700,036
Participant contributions at end of year	2014-12-31	$38,052
Participant contributions at beginning of year	2014-12-31	$43,808
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$132,914
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	$1,577,120
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$14,616,248
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$13,039,128
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$14,425,312
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$12,712,012
Interest on participant loans	2014-12-31	$1,630
Net investment gain/loss from pooled separate accounts	2014-12-31	$683,706
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	$591,346
Employer contributions (assets) at end of year	2014-12-31	$152,884
Employer contributions (assets) at beginning of year	2014-12-31	$283,308
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$504,299
Contract administrator fees	2014-12-31	$25,408
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	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	WIPFLI LLP
Accountancy firm EIN	2014-12-31	390758449
2013 : FIRST STATE BANK 401(K) PROFIT SHARING 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$3,105,534
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$191,557
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$170,835
Expenses. Certain deemed distributions of participant loans	2013-12-31	$6,008
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,246,607
Value of total assets at end of year	2013-12-31	$13,039,128
Value of total assets at beginning of year	2013-12-31	$10,125,151
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$14,714
Total interest from all sources	2013-12-31	$656
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
Administrative expenses professional fees incurred	2013-12-31	$750
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$579,765
Participant contributions at end of year	2013-12-31	$43,808
Participant contributions at beginning of year	2013-12-31	$30,994
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	$2,913,977
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$13,039,128
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$10,125,151
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$12,712,012
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$9,716,973
Interest on participant loans	2013-12-31	$656
Net investment gain/loss from pooled separate accounts	2013-12-31	$1,858,271
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	$666,842
Employer contributions (assets) at end of year	2013-12-31	$283,308
Employer contributions (assets) at beginning of year	2013-12-31	$377,184
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$170,835
Contract administrator fees	2013-12-31	$13,964
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	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	WIPFLI LLP
Accountancy firm EIN	2013-12-31	390758499

Form 5500 Responses for FIRST STATE BANK 401(K) PROFIT SHARING PLAN

2022: FIRST STATE BANK 401(K) PROFIT SHARING 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: FIRST STATE BANK 401(K) PROFIT SHARING 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: FIRST STATE BANK 401(K) PROFIT SHARING 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: FIRST STATE BANK 401(K) PROFIT SHARING 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
2018: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: FIRST STATE BANK 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: FIRST STATE BANK 401(K) PROFIT SHARING 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 benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: FIRST STATE BANK 401(K) PROFIT SHARING 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 benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: FIRST STATE BANK 401(K) PROFIT SHARING 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 – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

77977

Policy instance

Insurance contract or identification number	77977
Number of Individuals Covered	267
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $17,075
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 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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	15642
Additional information about fees paid to insurance broker	TPA FEES AND OTHER ALLOWANCES
Insurance broker organization code?	5

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

77977

Policy instance

Insurance contract or identification number	77977
Number of Individuals Covered	262
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 $16,955
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 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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	16955
Additional information about fees paid to insurance broker	TPA FEES AND OTHER ALLOWANCES
Insurance broker organization code?	5

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

77977

Policy instance

Insurance contract or identification number	77977
Number of Individuals Covered	262
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 $12,952
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 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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	12952
Additional information about fees paid to insurance broker	TPA FEES AND OTHER ALLOWANCES
Insurance broker organization code?	5

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

77977

Policy instance

Insurance contract or identification number	77977
Number of Individuals Covered	226
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $11,131
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 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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	11131
Additional information about fees paid to insurance broker	TPA FEES AND OTHER ALLOWANCES
Insurance broker organization code?	5

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

77977

Policy instance

Insurance contract or identification number	77977
Number of Individuals Covered	219
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $57,437
Total amount of fees paid to insurance company	USD $9,584
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 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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,437
Insurance broker organization code?	3
Amount paid for insurance broker fees	9581
Additional information about fees paid to insurance broker	TPA FEES AND OTHER ALLOWANCES
Insurance broker name	T. ROWE PRICE ASSOCIATES, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

77977

Policy instance

Insurance contract or identification number	77977
Number of Individuals Covered	213
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $45,296
Total amount of fees paid to insurance company	USD $7,591
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,296
Insurance broker organization code?	3
Amount paid for insurance broker fees	7591
Additional information about fees paid to insurance broker	TPA FEES AND OTHER ALLOWANCES
Insurance broker name	CROWE HORWATH LLP

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

77977

Policy instance

Insurance contract or identification number	77977
Number of Individuals Covered	210
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $40,853
Total amount of fees paid to insurance company	USD $6,818
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,853
Insurance broker organization code?	3
Amount paid for insurance broker fees	6818
Additional information about fees paid to insurance broker	TPA FEES AND OTHER ALLOWANCES
Insurance broker name	CROWE HORWATH LLP

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

77977

Policy instance

Insurance contract or identification number	77977
Number of Individuals Covered	184
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-01
Total amount of commissions paid to insurance broker	USD $33,444
Total amount of fees paid to insurance company	USD $5,580
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,444
Insurance broker organization code?	3
Amount paid for insurance broker fees	5580
Additional information about fees paid to insurance broker	TPA FEES AND OTHER ALLOWANCES
Insurance broker name	CROWE HORWATH LLP

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Company Name:	FIRST STATE BANK
Employer identification number (EIN):	361465165
NAIC Classification:	522110
NAIC Description:	Commercial Banking