FIRST STATE BANK HEALTH REIMBURSEMENT ARRANGEMENT 401k Plan overview

FIRST STATE BANK HEALTH REIMBURSEMENT ARRANGEMENT Benefits

401k Sponsoring company profile

Company Name:	FIRST STATE BANK
Employer identification number (EIN):	620401160
NAIC Classification:	522110
NAIC Description:	Commercial Banking

Form 5500 Filing Information

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
525	2015-01-01	KATHY BARBER
525	2014-01-01	KATHY BARBER
525	2013-01-01	KATHY BARBER
525	2012-01-01	KATHY BARBER
525	2011-01-01	KATHY BARBER
525	2009-01-01	KATHY BARBER

Plan Statistics for FIRST STATE BANK HEALTH REIMBURSEMENT ARRANGEMENT

Measure	Date	Value
2015: FIRST STATE BANK HEALTH REIMBURSEMENT ARRANGEMENT 2015 401k membership
Total participants, beginning-of-year	2015-01-01	354
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
2014: FIRST STATE BANK HEALTH REIMBURSEMENT ARRANGEMENT 2014 401k membership
Total participants, beginning-of-year	2014-01-01	380
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	359
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	359
2013: FIRST STATE BANK HEALTH REIMBURSEMENT ARRANGEMENT 2013 401k membership
Total participants, beginning-of-year	2013-01-01	362
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	366
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	366
2012: FIRST STATE BANK HEALTH REIMBURSEMENT ARRANGEMENT 2012 401k membership
Total participants, beginning-of-year	2012-01-01	328
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	353
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	353
2011: FIRST STATE BANK HEALTH REIMBURSEMENT ARRANGEMENT 2011 401k membership
Total participants, beginning-of-year	2011-01-01	310
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	322
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	322
2009: FIRST STATE BANK HEALTH REIMBURSEMENT ARRANGEMENT 2009 401k membership
Total participants, beginning-of-year	2009-01-01	356
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	327
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	327

Form 5500 Responses for FIRST STATE BANK HEALTH REIMBURSEMENT ARRANGEMENT

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• FIRST STATE BANK AND TRUST EMPLOYEE BENEFICIARY ASSOCIATION HEALTH & WELFARE PLAN [EIN = 410257270]
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• FIRST STATE BANK 401(K) PLAN [EIN = 750989466]
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• FIRST STATE MEDICAL ASSOCIATES 401(K) PROFIT SHARING PLAN & TRUST [EIN = 208580437]
• FIRST STATE FINANCIAL 401(K) PROFIT SHARING PLAN [EIN = 610192880]
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• FIRST STATE BANK OF ST. CHARLES MISSOURI 401(K) PLAN [EIN = 430492450]
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• FIRST STATE FINANCIAL, INC. [EIN = 610192880]
• FIRST STATE BANK OF MIDDLEBURY 401(K) PROFIT SHARING PLAN [EIN = 350310540]
• FIRST STATE BANK OF SIOUX RAPIDS PROFIT SHARING PLAN AND TRUST [EIN = 420253630]
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• FIRST STATE BANK OF MALTA PENSION PLAN [EIN = 810135460]
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• FIRST STATE BANK OF DEKALB COUNTY 401(K) PS PLAN [EIN = 630817863]
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• FIRST STATE BANCORP, INC. COMBINED RETIREMENT BENEFIT PLAN [EIN = 431281074]
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• FIRST STATE BANK RETIREMENT PLAN [EIN = 620201630]
• FIRST STATE BANK EMPLOYEES PROFIT SHARING PLAN [EIN = 730237190]
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• FIRST STATE BANCSHARES, INC. EMPLOYEES FLEXIBLE BENEFIT PLAN [EIN = 431345560]
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• FIRST STATE BANCSHARES, INC. EMPLOYEE LIFE AND LTD BENEFIT PLAN [EIN = 431345560]
• FIRST STATE BANCSHARES, INC. EMPLOYEE DENTAL BENEFIT PLAN [EIN = 431345560]
• FIRST STATE BANK OF WINCHESTER 401(K) PROFIT SHARING PLAN [EIN = 370275150]
• FIRST STATE ORAL & MAXILLOFACIAL SURGERY CORP. CASH BALANCE PLAN [EIN = 208643759]
• FIRST STATE DENTAL, P.A. CASH BALANCE PLAN [EIN = 204711056]
• FIRST STATE BANK EMPLOYEE BENEFITS PLAN [EIN = 650741232]
• FIRST STATE WOMEN S CARE, P.A. 401(K) PROFIT SHARING PLAN [EIN = 510273348]
• FIRST STATE CORPORATION 401(K) PLAN [EIN = 510266307]
• FIRST STATE BANK 401(K) PLAN [EIN = 540188370]
• FIRST STATE BANK 401(K) PLAN [EIN = 740730847]
• FIRST STATE BANK OF ALEXANDRIA 401K PLAN [EIN = 410257340]
• FIRST STATE BANK OF HALLSVILLE EMPLOYEE PENSION PLAN [EIN = 750270460]
• FIRST STATE BANK OF SHELTON, NE PENSION PLAN [EIN = 470162810]
• FIRST STATEWIDE REALTY INVES 401 K PROFIT SHARING PLAN TRUST [EIN = 824420446]
• FIRST STATE FLEET SERVICE, INC. 401(K) PLAN [EIN = 271371997]
• FIRST STATE ROOF & EXTERIOR CL 401(K) PROFIT SHARING PLAN & TRUST [EIN = 831742021]
• FIRST STATE AUTO GROUP 401(K) PLAN [EIN = 465562783]
• FIRST STATE INVESTMENTS 401(K) SAVINGS PLAN [EIN = 464637910]
• FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN [EIN = 740625760]
• FIRST STATE BANK OF UVALDE LTD PLAN [EIN = 740625760]
• FIRST STATE BANK OF BLAKELY DEFINED CONTRIBUTION PLAN [EIN = 580243255]
• FIRST STATE BANK OF ST. CHARLES HEALTH AND WELFARE BENEFITS PLAN [EIN = 430492450]
• FIRST STATE BANK OF WARREN MONEY PURCHASE PLAN [EIN = 710332672]
• FIRST STATE BANK OF WARREN PROFIT SHARING PLAN [EIN = 710332672]
• FIRST STATE BANK OF UVALDE 401(K) PLAN [EIN = 740625760]
• FIRST STATE BANK OMAHA 401(K) P/S PLAN [EIN = 470162740]
• FIRST STATE ACTION FUND INC. 401(K) PLAN [EIN = 842574164]
• FIRST STATE BANCORP INC MEDOVA LIFESTYLE HEALTH PLAN [EIN = 431281074]
• FIRST STATE BANK, CLUTE EMPLOYEE SAVINGS PLAN [EIN = 741311733]
• FIRST STATE HOSPITALITY, LLC CASH BALANCE PLAN [EIN = 472582921]
• FIRST STATE BREWING COMPANY 401(K) PLAN [EIN = 472051133]
• FIRST STATE BANK OF SHALLOWATER 401K [EIN = 751051510]

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