401k Plan data: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN plan

FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 401k Plan overview

Plan Name	FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN
Plan identification number	001

FIRST STATE HOLDING CO. 401(K) RETIREMENT 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan covering Self-Employed individuals.
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 HOLDING CO. has sponsored the creation of one or more 401k plans.

Company Name: FIRST STATE HOLDING CO.

Employer identification number (EIN): 470593732

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 MIRANDA J. HOBELMAN 2023-10-15 MIRANDA J. HOBELMAN 2023-10-08
001 2021-01-01 MIRANDA HOBELMAN 2022-10-16 MIRANDA HOBELMAN 2022-10-16
001 2020-01-01 MIRANDA HOBELMAN 2021-10-13 MIRANDA HOBELMAN 2021-10-13
001 2019-01-01 LINDSAY SELIG 2020-10-13 LINDSAY SELIG 2020-10-13
001 2018-01-01 LINDSAY SELIG 2019-10-14 LINDSAY SELIG 2019-10-14
001 2017-01-01
001 2016-01-01
001 2015-01-01 MILTON A. WILLNERD
001 2014-01-01 MILTON A. WILLNERD
001 2013-01-01
001 2012-01-01 PAULA HALL
001 2011-01-01 PAULA HALL PAULA HALL 2012-10-12
001 2010-01-01 PAULA J HALL 2011-07-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	MIRANDA J. HOBELMAN	2023-10-15	MIRANDA J. HOBELMAN	2023-10-08
001	2021-01-01	MIRANDA HOBELMAN	2022-10-16	MIRANDA HOBELMAN	2022-10-16
001	2020-01-01	MIRANDA HOBELMAN	2021-10-13	MIRANDA HOBELMAN	2021-10-13
001	2019-01-01	LINDSAY SELIG	2020-10-13	LINDSAY SELIG	2020-10-13
001	2018-01-01	LINDSAY SELIG	2019-10-14	LINDSAY SELIG	2019-10-14
001	2017-01-01
001	2016-01-01
001	2015-01-01	MILTON A. WILLNERD
001	2014-01-01	MILTON A. WILLNERD
001	2013-01-01
001	2012-01-01	PAULA HALL
001	2011-01-01	PAULA HALL		PAULA HALL	2012-10-12
001	2010-01-01	PAULA J HALL	2011-07-29

Plan Statistics for FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN

401k plan membership statisitcs for FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN

Measure Date Value
2022: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 182
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 152
Number of retired or separated participants receiving benefits 2022-01-01 5
Number of other retired or separated participants entitled to future benefits 2022-01-01 35
Total of all active and inactive participants 2022-01-01 192
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 192
Number of participants with account balances 2022-01-01 186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 17
2021: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 182
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 145
Number of retired or separated participants receiving benefits 2021-01-01 4
Number of other retired or separated participants entitled to future benefits 2021-01-01 33
Total of all active and inactive participants 2021-01-01 182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 182
Number of participants with account balances 2021-01-01 178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 8
2020: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 144
Number of retired or separated participants receiving benefits 2020-01-01 5
Number of other retired or separated participants entitled to future benefits 2020-01-01 29
Total of all active and inactive participants 2020-01-01 178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 178
Number of participants with account balances 2020-01-01 172
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 11
2019: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 130
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 31
Total of all active and inactive participants 2019-01-01 161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 161
Number of participants with account balances 2019-01-01 161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 9
2018: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 134
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 27
Total of all active and inactive participants 2018-01-01 161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 161
Number of participants with account balances 2018-01-01 156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 7
2017: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 136
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 26
Total of all active and inactive participants 2017-01-01 164
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 164
Number of participants with account balances 2017-01-01 158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 8
2016: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 131
Number of retired or separated participants receiving benefits 2016-01-01 2
Number of other retired or separated participants entitled to future benefits 2016-01-01 28
Total of all active and inactive participants 2016-01-01 161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 161
Number of participants with account balances 2016-01-01 154
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 2
2015: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 130
Number of retired or separated participants receiving benefits 2015-01-01 2
Number of other retired or separated participants entitled to future benefits 2015-01-01 19
Total of all active and inactive participants 2015-01-01 151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 151
Number of participants with account balances 2015-01-01 145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 5
2014: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 123
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 14
Total of all active and inactive participants 2014-01-01 140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 140
Number of participants with account balances 2014-01-01 134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 5
2013: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 127
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 14
Total of all active and inactive participants 2013-01-01 141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 141
Number of participants with account balances 2013-01-01 131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 129
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 9
Total of all active and inactive participants 2012-01-01 140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 140
Number of participants with account balances 2012-01-01 130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 120
Number of retired or separated participants receiving benefits 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 7
Total of all active and inactive participants 2011-01-01 129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 129
Number of participants with account balances 2011-01-01 118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 3

Measure	Date	Value
2022: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	182
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	152
Number of retired or separated participants receiving benefits	2022-01-01	5
Number of other retired or separated participants entitled to future benefits	2022-01-01	35
Total of all active and inactive participants	2022-01-01	192
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	192
Number of participants with account balances	2022-01-01	186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	17
2021: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	182
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	145
Number of retired or separated participants receiving benefits	2021-01-01	4
Number of other retired or separated participants entitled to future benefits	2021-01-01	33
Total of all active and inactive participants	2021-01-01	182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	182
Number of participants with account balances	2021-01-01	178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	8
2020: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	144
Number of retired or separated participants receiving benefits	2020-01-01	5
Number of other retired or separated participants entitled to future benefits	2020-01-01	29
Total of all active and inactive participants	2020-01-01	178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	178
Number of participants with account balances	2020-01-01	172
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	11
2019: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	130
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	31
Total of all active and inactive participants	2019-01-01	161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	161
Number of participants with account balances	2019-01-01	161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	9
2018: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	134
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	27
Total of all active and inactive participants	2018-01-01	161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	161
Number of participants with account balances	2018-01-01	156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	7
2017: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	136
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	26
Total of all active and inactive participants	2017-01-01	164
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	164
Number of participants with account balances	2017-01-01	158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	8
2016: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	131
Number of retired or separated participants receiving benefits	2016-01-01	2
Number of other retired or separated participants entitled to future benefits	2016-01-01	28
Total of all active and inactive participants	2016-01-01	161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	161
Number of participants with account balances	2016-01-01	154
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2
2015: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	130
Number of retired or separated participants receiving benefits	2015-01-01	2
Number of other retired or separated participants entitled to future benefits	2015-01-01	19
Total of all active and inactive participants	2015-01-01	151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	151
Number of participants with account balances	2015-01-01	145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	5
2014: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	123
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	14
Total of all active and inactive participants	2014-01-01	140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	140
Number of participants with account balances	2014-01-01	134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	5
2013: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	127
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	14
Total of all active and inactive participants	2013-01-01	141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	141
Number of participants with account balances	2013-01-01	131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	129
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	9
Total of all active and inactive participants	2012-01-01	140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	140
Number of participants with account balances	2012-01-01	130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	120
Number of retired or separated participants receiving benefits	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	7
Total of all active and inactive participants	2011-01-01	129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	129
Number of participants with account balances	2011-01-01	118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	3

Financial Data on FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN

Measure	Date	Value
2022 : FIRST STATE HOLDING CO. 401(K) RETIREMENT 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	$-1,493,959
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$612,506
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$574,556
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,203,815
Value of total assets at end of year	2022-12-31	$14,293,363
Value of total assets at beginning of year	2022-12-31	$16,399,828
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$37,950
Total interest from all sources	2022-12-31	$9,786
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$854,210
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$854,210
Administrative expenses professional fees incurred	2022-12-31	$0
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$8,000,000
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	$799,881
Participant contributions at end of year	2022-12-31	$54,894
Participant contributions at beginning of year	2022-12-31	$42,152
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$2,129
Administrative expenses (other) incurred	2022-12-31	$0
Total non interest bearing cash at end of year	2022-12-31	$0
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
Income. Non cash contributions	2022-12-31	$0
Value of net income/loss	2022-12-31	$-2,106,465
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$14,293,363
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$16,399,828
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	$33,678
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$13,593,396
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$15,364,845
Interest on participant loans	2022-12-31	$2,526
Interest earned on other investments	2022-12-31	$7,260
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$645,073
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$992,831
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-3,561,770
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	$401,805
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$574,556
Contract administrator fees	2022-12-31	$4,272
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	BERGANKDV
Accountancy firm EIN	2022-12-31	813053687
2021 : FIRST STATE HOLDING CO. 401(K) RETIREMENT 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	$3,054,897
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$529,841
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$493,639
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$1,206,697
Value of total assets at end of year	2021-12-31	$16,399,828
Value of total assets at beginning of year	2021-12-31	$13,874,772
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$36,202
Total interest from all sources	2021-12-31	$10,376
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$607,611
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$607,611
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$6,000,000
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	$781,394
Participant contributions at end of year	2021-12-31	$42,152
Participant contributions at beginning of year	2021-12-31	$57,961
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$47,744
Total non interest bearing cash at end of year	2021-12-31	$5,432
Total non interest bearing cash at beginning of year	2021-12-31	$5,384
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	$2,525,056
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$16,399,828
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$13,874,772
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	$34,482
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$15,364,845
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$12,972,460
Interest on participant loans	2021-12-31	$2,672
Interest earned on other investments	2021-12-31	$7,704
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$987,399
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$838,967
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$1,230,213
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	$377,559
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$493,639
Contract administrator fees	2021-12-31	$1,720
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	Unqualified
Accountancy firm name	2021-12-31	BERGANKDV
Accountancy firm EIN	2021-12-31	813053687
2020 : FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
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	$3,670,848
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$1,815,074
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$1,785,937
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,817,400
Value of total assets at end of year	2020-12-31	$13,874,772
Value of total assets at beginning of year	2020-12-31	$12,018,998
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$29,137
Total interest from all sources	2020-12-31	$10,658
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$450,946
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$450,946
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$6,000,000
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	$716,451
Participant contributions at end of year	2020-12-31	$57,961
Participant contributions at beginning of year	2020-12-31	$38,545
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$762,685
Total non interest bearing cash at end of year	2020-12-31	$5,384
Total non interest bearing cash at beginning of year	2020-12-31	$5,328
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	$1,855,774
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$13,874,772
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$12,018,998
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	$27,657
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$12,972,460
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$11,246,431
Interest on participant loans	2020-12-31	$2,216
Interest earned on other investments	2020-12-31	$8,442
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$838,967
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$728,694
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$1,391,844
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	$338,264
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$1,785,937
Contract administrator fees	2020-12-31	$1,480
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	BERGANKDV, LLC
Accountancy firm EIN	2020-12-31	813053687
2019 : FIRST STATE HOLDING CO. 401(K) RETIREMENT 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	$3,063,111
Total income from all sources (including contributions)	2019-12-31	$3,063,111
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	$915,776
Total of all expenses incurred	2019-12-31	$915,776
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$888,979
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$888,979
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$968,294
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$968,294
Value of total assets at end of year	2019-12-31	$12,018,998
Value of total assets at end of year	2019-12-31	$12,018,998
Value of total assets at beginning of year	2019-12-31	$9,871,663
Value of total assets at beginning of year	2019-12-31	$9,871,663
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$26,797
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$26,797
Total interest from all sources	2019-12-31	$10,289
Total interest from all sources	2019-12-31	$10,289
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$426,989
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$426,989
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
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$426,989
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$426,989
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	$6,000,000
Value of fidelity bond cover	2019-12-31	$6,000,000
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	$654,375
Contributions received from participants	2019-12-31	$654,375
Participant contributions at end of year	2019-12-31	$38,545
Participant contributions at end of year	2019-12-31	$38,545
Participant contributions at beginning of year	2019-12-31	$7,042
Participant contributions at beginning of year	2019-12-31	$7,042
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$7,433
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$7,433
Total non interest bearing cash at end of year	2019-12-31	$5,328
Total non interest bearing cash at beginning of year	2019-12-31	$5,248
Total non interest bearing cash at beginning of year	2019-12-31	$5,248
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	$2,147,335
Value of net income/loss	2019-12-31	$2,147,335
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$12,018,998
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$12,018,998
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$9,871,663
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$9,871,663
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	$24,860
Investment advisory and management fees	2019-12-31	$24,860
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$11,246,431
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$11,246,431
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$9,101,825
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$9,101,825
Interest on participant loans	2019-12-31	$1,030
Interest on participant loans	2019-12-31	$1,030
Interest earned on other investments	2019-12-31	$9,259
Interest earned on other investments	2019-12-31	$9,259
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$728,694
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$728,694
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$757,548
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$757,548
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$1,657,539
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$1,657,539
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	Yes
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
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	$306,486
Contributions received in cash from employer	2019-12-31	$306,486
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$888,979
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$888,979
Contract administrator fees	2019-12-31	$1,937
Contract administrator fees	2019-12-31	$1,937
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	BERGANKDV, LLC
Accountancy firm name	2019-12-31	BERGANKDV, LLC
Accountancy firm EIN	2019-12-31	813053687
Accountancy firm EIN	2019-12-31	813053687
2018 : FIRST STATE HOLDING CO. 401(K) RETIREMENT 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	$359,802
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$268,937
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$259,038
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$966,976
Value of total assets at end of year	2018-12-31	$9,871,663
Value of total assets at beginning of year	2018-12-31	$9,780,798
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$9,899
Total interest from all sources	2018-12-31	$7,484
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$858,752
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$858,752
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$6,000,000
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	$657,974
Participant contributions at end of year	2018-12-31	$7,042
Participant contributions at beginning of year	2018-12-31	$3,239
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$11,652
Administrative expenses (other) incurred	2018-12-31	$9,899
Total non interest bearing cash at end of year	2018-12-31	$5,248
Total non interest bearing cash at beginning of year	2018-12-31	$5,186
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	$90,865
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$9,871,663
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$9,780,798
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$9,101,825
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$9,070,370
Interest on participant loans	2018-12-31	$118
Interest earned on other investments	2018-12-31	$7,366
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$757,548
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$702,003
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-1,473,410
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	$297,350
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$259,038
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	BERGANKDV, LLC
Accountancy firm EIN	2018-12-31	453576904
2017 : FIRST STATE HOLDING CO. 401(K) RETIREMENT 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	$2,345,910
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$544,747
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$544,703
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$834,911
Value of total assets at end of year	2017-12-31	$9,780,798
Value of total assets at beginning of year	2017-12-31	$7,979,635
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$44
Total interest from all sources	2017-12-31	$8,059
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$593,695
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$593,695
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$6,000,000
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	$551,360
Participant contributions at end of year	2017-12-31	$3,239
Participant contributions at beginning of year	2017-12-31	$22,795
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$31,596
Administrative expenses (other) incurred	2017-12-31	$44
Total non interest bearing cash at end of year	2017-12-31	$5,186
Total non interest bearing cash at beginning of year	2017-12-31	$4,287
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	$1,801,163
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$9,780,798
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$7,979,635
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	$9,070,370
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$7,182,423
Interest on participant loans	2017-12-31	$675
Interest earned on other investments	2017-12-31	$7,384
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$702,003
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$770,130
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$909,245
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	$251,955
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$544,703
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	HSMC ORIZON, LLC
Accountancy firm EIN	2017-12-31	453576904
2016 : FIRST STATE HOLDING CO. 401(K) RETIREMENT 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	$1,259,730
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$412,509
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$412,271
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$764,427
Value of total assets at end of year	2016-12-31	$7,979,635
Value of total assets at beginning of year	2016-12-31	$7,132,414
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$238
Total interest from all sources	2016-12-31	$10,167
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$351,666
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$351,666
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$6,000,000
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	$480,953
Participant contributions at end of year	2016-12-31	$22,795
Participant contributions at beginning of year	2016-12-31	$39,124
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$48,374
Administrative expenses (other) incurred	2016-12-31	$238
Total non interest bearing cash at end of year	2016-12-31	$4,287
Total non interest bearing cash at beginning of year	2016-12-31	$2,290
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	$847,221
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$7,979,635
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$7,132,414
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	$7,182,423
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$6,319,126
Interest on participant loans	2016-12-31	$1,291
Interest earned on other investments	2016-12-31	$8,876
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$770,130
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$771,874
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$133,470
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	$235,100
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$412,271
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	HSMC ORIZON, LLC
Accountancy firm EIN	2016-12-31	453576904
2015 : FIRST STATE HOLDING CO. 401(K) RETIREMENT 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	$899,204
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$292,343
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$264,688
Expenses. Certain deemed distributions of participant loans	2015-12-31	$27,367
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$855,733
Value of total assets at end of year	2015-12-31	$7,132,414
Value of total assets at beginning of year	2015-12-31	$6,525,553
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$288
Total interest from all sources	2015-12-31	$11,153
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$438,902
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$438,902
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$4,750,000
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	$457,371
Participant contributions at end of year	2015-12-31	$39,124
Participant contributions at beginning of year	2015-12-31	$76,800
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$167,410
Administrative expenses (other) incurred	2015-12-31	$288
Total non interest bearing cash at end of year	2015-12-31	$2,290
Total non interest bearing cash at beginning of year	2015-12-31	$502
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	$606,861
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$7,132,414
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$6,525,553
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	$6,319,126
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$5,711,700
Interest on participant loans	2015-12-31	$2,178
Interest earned on other investments	2015-12-31	$8,975
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$771,874
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$736,551
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-406,584
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	Yes
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	$230,952
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$264,688
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	HSMC ORIZON LLC
Accountancy firm EIN	2015-12-31	453576904
2014 : FIRST STATE HOLDING CO. 401(K) RETIREMENT 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	$946,963
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$985,089
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$984,751
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$599,213
Value of total assets at end of year	2014-12-31	$6,525,051
Value of total assets at beginning of year	2014-12-31	$6,563,177
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$338
Total interest from all sources	2014-12-31	$11,289
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$410,987
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$410,987
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$4,750,000
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	$392,628
Participant contributions at end of year	2014-12-31	$76,800
Participant contributions at beginning of year	2014-12-31	$79,458
Participant contributions at beginning of year	2014-12-31	$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	2014-12-31	No
Value of net income/loss	2014-12-31	$-38,126
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$6,525,051
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$6,563,177
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	$5,711,700
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$5,894,698
Interest on participant loans	2014-12-31	$3,149
Interest earned on other investments	2014-12-31	$8,140
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$736,551
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$589,021
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$-74,526
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	$206,585
Employer contributions (assets) at beginning of year	2014-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$984,751
Contract administrator fees	2014-12-31	$338
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	HSMC ORIZON LLC
Accountancy firm EIN	2014-12-31	453576904
2013 : FIRST STATE HOLDING CO. 401(K) RETIREMENT 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	$1,716,456
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$415,454
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$415,210
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$638,331
Value of total assets at end of year	2013-12-31	$6,563,177
Value of total assets at beginning of year	2013-12-31	$5,262,175
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$244
Total interest from all sources	2013-12-31	$9,154
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$164,904
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$164,904
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$4,750,000
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	$424,970
Participant contributions at end of year	2013-12-31	$79,458
Participant contributions at beginning of year	2013-12-31	$52,172
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$39,050
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$5,447
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	$1,301,002
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$6,563,177
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$5,262,175
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	$5,894,698
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$4,544,572
Interest on participant loans	2013-12-31	$2,185
Interest earned on other investments	2013-12-31	$6,969
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$589,021
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$616,048
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$904,067
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	$207,914
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$10,333
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$415,210
Contract administrator fees	2013-12-31	$244
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	HSMC ORIZON, LLC
Accountancy firm EIN	2013-12-31	453576904
2012 : FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of real estate assets	2012-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$0
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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Expenses. Interest paid	2012-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$1,193,886
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$125,281
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$113,394
Expenses. Certain deemed distributions of participant loans	2012-12-31	$9,511
Value of total corrective distributions	2012-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$641,145
Value of total assets at end of year	2012-12-31	$5,262,175
Value of total assets at beginning of year	2012-12-31	$4,193,570
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$2,376
Total income from rents	2012-12-31	$0
Total interest from all sources	2012-12-31	$10,470
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
Assets. Real estate other than employer real property at end of year	2012-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2012-12-31	$0
Administrative expenses professional fees incurred	2012-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2012-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$3,500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$369,739
Participant contributions at end of year	2012-12-31	$52,172
Participant contributions at beginning of year	2012-12-31	$64,131
Participant contributions at end of year	2012-12-31	$39,050
Participant contributions at beginning of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2012-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$75,015
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Assets. Loans (other than to participants) at end of year	2012-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2012-12-31	$0
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	$0
Other income not declared elsewhere	2012-12-31	$107,047
Administrative expenses (other) incurred	2012-12-31	$0
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	$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	2012-12-31	No
Income. Non cash contributions	2012-12-31	$0
Value of net income/loss	2012-12-31	$1,068,605
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$5,262,175
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$4,193,570
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
Assets. partnership/joint venture interests at end of year	2012-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2012-12-31	$0
Investment advisory and management fees	2012-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$4,544,572
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$3,634,975
Interest on participant loans	2012-12-31	$2,095
Income. Interest from loans (other than to participants)	2012-12-31	$0
Interest earned on other investments	2012-12-31	$8,375
Income. Interest from US Government securities	2012-12-31	$0
Income. Interest from corporate debt instruments	2012-12-31	$0
Value of interest in master investment trust accounts at end of year	2012-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2012-12-31	$0
Value of interest in common/collective trusts at end of year	2012-12-31	$0
Value of interest in common/collective trusts at beginning of year	2012-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2012-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$616,048
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$494,464
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$0
Asset value of US Government securities at end of year	2012-12-31	$0
Asset value of US Government securities at beginning of year	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$435,224
Net investment gain/loss from pooled separate accounts	2012-12-31	$0
Net investment gain or loss from common/collective trusts	2012-12-31	$0
Net gain/loss from 103.12 investment entities	2012-12-31	$0
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
Assets. Invements in employer securities at end of year	2012-12-31	$0
Assets. Invements in employer securities at beginning of year	2012-12-31	$0
Assets. Value of employer real property at end of year	2012-12-31	$0
Assets. Value of employer real property at beginning of year	2012-12-31	$0
Contributions received in cash from employer	2012-12-31	$196,391
Employer contributions (assets) at end of year	2012-12-31	$10,333
Employer contributions (assets) at beginning of year	2012-12-31	$0
Income. Dividends from preferred stock	2012-12-31	$0
Income. Dividends from common stock	2012-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$113,394
Asset. Corporate debt instrument preferred debt at end of year	2012-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2012-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2012-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2012-12-31	$0
Contract administrator fees	2012-12-31	$2,376
Assets. Corporate common stocks other than exployer securities at end of year	2012-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2012-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2012-12-31	$0
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
Aggregate proceeds on sale of assets	2012-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2012-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2012-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	WILLNERD & ASSOCIATES
Accountancy firm EIN	2012-12-31	201689606
2011 : FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets	2011-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$0
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total transfer of assets to this plan	2011-12-31	$0
Total transfer of assets from this plan	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Expenses. Interest paid	2011-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$367,171
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$93,950
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$93,325
Expenses. Certain deemed distributions of participant loans	2011-12-31	$0
Value of total corrective distributions	2011-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$539,827
Value of total assets at end of year	2011-12-31	$4,193,570
Value of total assets at beginning of year	2011-12-31	$3,920,349
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$625
Total income from rents	2011-12-31	$0
Total interest from all sources	2011-12-31	$11,936
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$86,619
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$86,619
Assets. Real estate other than employer real property at end of year	2011-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2011-12-31	$0
Administrative expenses professional fees incurred	2011-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2011-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2011-12-31	$0
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$3,500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$343,252
Participant contributions at end of year	2011-12-31	$64,131
Participant contributions at beginning of year	2011-12-31	$76,988
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2011-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$16,417
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$0
Assets. Loans (other than to participants) at end of year	2011-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$0
Administrative expenses (other) incurred	2011-12-31	$0
Total non interest bearing cash at end of year	2011-12-31	$0
Total non interest bearing cash at beginning of year	2011-12-31	$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	2011-12-31	No
Income. Non cash contributions	2011-12-31	$0
Value of net income/loss	2011-12-31	$273,221
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$4,193,570
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$3,920,349
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
Assets. partnership/joint venture interests at end of year	2011-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2011-12-31	$0
Investment advisory and management fees	2011-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$3,634,975
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$3,372,134
Value of interest in pooled separate accounts at end of year	2011-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$0
Interest on participant loans	2011-12-31	$2,777
Income. Interest from loans (other than to participants)	2011-12-31	$0
Interest earned on other investments	2011-12-31	$9,159
Income. Interest from US Government securities	2011-12-31	$0
Income. Interest from corporate debt instruments	2011-12-31	$0
Value of interest in master investment trust accounts at end of year	2011-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2011-12-31	$0
Value of interest in common/collective trusts at end of year	2011-12-31	$0
Value of interest in common/collective trusts at beginning of year	2011-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2011-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$494,464
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$471,227
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$0
Asset value of US Government securities at end of year	2011-12-31	$0
Asset value of US Government securities at beginning of year	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-271,211
Net investment gain/loss from pooled separate accounts	2011-12-31	$0
Net investment gain or loss from common/collective trusts	2011-12-31	$0
Net gain/loss from 103.12 investment entities	2011-12-31	$0
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
Assets. Invements in employer securities at end of year	2011-12-31	$0
Assets. Invements in employer securities at beginning of year	2011-12-31	$0
Assets. Value of employer real property at end of year	2011-12-31	$0
Assets. Value of employer real property at beginning of year	2011-12-31	$0
Contributions received in cash from employer	2011-12-31	$180,158
Employer contributions (assets) at end of year	2011-12-31	$0
Employer contributions (assets) at beginning of year	2011-12-31	$0
Income. Dividends from preferred stock	2011-12-31	$0
Income. Dividends from common stock	2011-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$93,325
Asset. Corporate debt instrument preferred debt at end of year	2011-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2011-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2011-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2011-12-31	$0
Contract administrator fees	2011-12-31	$625
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2011-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2011-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2011-12-31	$0
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
Aggregate proceeds on sale of assets	2011-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2011-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2011-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	WILLNERD & ASSOCIATES, LLC.
Accountancy firm EIN	2011-12-31	201689606

Form 5500 Responses for FIRST STATE HOLDING CO. 401(K) RETIREMENT PLAN

2022: FIRST STATE HOLDING CO. 401(K) RETIREMENT 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 HOLDING CO. 401(K) RETIREMENT 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 HOLDING CO. 401(K) RETIREMENT 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 HOLDING CO. 401(K) RETIREMENT 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 HOLDING CO. 401(K) RETIREMENT 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 HOLDING CO. 401(K) RETIREMENT 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 HOLDING CO. 401(K) RETIREMENT 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 HOLDING CO. 401(K) RETIREMENT 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 HOLDING CO. 401(K) RETIREMENT 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 HOLDING CO. 401(K) RETIREMENT 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
2012: FIRST STATE HOLDING CO. 401(K) RETIREMENT 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 – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: FIRST STATE HOLDING CO. 401(K) RETIREMENT 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 – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

384624-01

Policy instance

Insurance contract or identification number	384624-01
Number of Individuals Covered	24
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

384624-01

Policy instance

Insurance contract or identification number	384624-01
Number of Individuals Covered	27
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

384624-01

Policy instance

Insurance contract or identification number	384624-01
Number of Individuals Covered	25
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 $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

384624-01

Policy instance

Insurance contract or identification number	384624-01
Number of Individuals Covered	23
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 $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

384624-01

Policy instance

Insurance contract or identification number	384624-01
Number of Individuals Covered	25
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

384624-01

Policy instance

Insurance contract or identification number	384624-01
Number of Individuals Covered	27
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

384624-01

Policy instance

Insurance contract or identification number	384624-01
Number of Individuals Covered	38
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

384624-01

Policy instance

Insurance contract or identification number	384624-01
Number of Individuals Covered	43
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

384624-01

Policy instance

Insurance contract or identification number	384624-01
Number of Individuals Covered	30
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
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	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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

384624-01

Policy instance

Insurance contract or identification number	384624-01
Number of Individuals Covered	31
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $715
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?	Yes
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 $429
Insurance broker organization code?	3
Insurance broker name	SMITH HAYES FINANCIAL SERVICES CORP

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

384624-01

Policy instance

Insurance contract or identification number	384624-01
Number of Individuals Covered	30
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $975
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?	Yes
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

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Company Name:	FIRST STATE HOLDING CO.
Employer identification number (EIN):	470593732
NAIC Classification:	522110
NAIC Description:	Commercial Banking