401k Plan data: FIRST STATE BANK SAVINGS INCENTIVE PLAN plan

FIRST STATE BANK SAVINGS INCENTIVE PLAN 401k Plan overview

Plan Name	FIRST STATE BANK SAVINGS INCENTIVE PLAN
Plan identification number	001

FIRST STATE BANK SAVINGS INCENTIVE PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

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

Company Name: FIRST STATE BANK OF FAIRFAX

Employer identification number (EIN): 730242080

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST STATE BANK SAVINGS INCENTIVE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 KEITH CLAYBROOK
001 2014-01-01 KEITH CLAYBROOK
001 2013-01-01 JAMI BURGESS
001 2012-01-01 MARGARET L ELSBERRY
001 2011-01-01 MAX ELSBERRY
001 2009-01-01 MAX ELSBERRY

Plan id#	Filing Submission Date	Name of Administrator
001	2015-01-01	KEITH CLAYBROOK
001	2014-01-01	KEITH CLAYBROOK
001	2013-01-01	JAMI BURGESS
001	2012-01-01	MARGARET L ELSBERRY
001	2011-01-01	MAX ELSBERRY
001	2009-01-01	MAX ELSBERRY

Plan Statistics for FIRST STATE BANK SAVINGS INCENTIVE PLAN

401k plan membership statisitcs for FIRST STATE BANK SAVINGS INCENTIVE PLAN

Measure Date Value
2015: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 14
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
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Number of retired or separated participants receiving benefits 2014-01-01 14
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 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 14
Number of participants with account balances 2014-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 9
Number of retired or separated participants receiving benefits 2013-01-01 3
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 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 12
Number of participants with account balances 2013-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 19
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 2
Total of all active and inactive participants 2012-01-01 21
Total participants 2012-01-01 21
Number of participants with account balances 2012-01-01 18
2011: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 20
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 2
Total of all active and inactive participants 2011-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 22
Number of participants with account balances 2011-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 21
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 3
Total of all active and inactive participants 2009-01-01 24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 24
Number of participants with account balances 2009-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2015: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	14
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
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Number of retired or separated participants receiving benefits	2014-01-01	14
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	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	14
Number of participants with account balances	2014-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	9
Number of retired or separated participants receiving benefits	2013-01-01	3
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	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	12
Number of participants with account balances	2013-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	19
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	2
Total of all active and inactive participants	2012-01-01	21
Total participants	2012-01-01	21
Number of participants with account balances	2012-01-01	18
2011: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	20
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	2
Total of all active and inactive participants	2011-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	22
Number of participants with account balances	2011-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	21
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	3
Total of all active and inactive participants	2009-01-01	24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	24
Number of participants with account balances	2009-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on FIRST STATE BANK SAVINGS INCENTIVE PLAN

Measure	Date	Value
2015 : FIRST STATE BANK SAVINGS INCENTIVE PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$-103,646
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$-4,461
Total plan assets at end of year	2015-12-31	$0
Total plan assets at beginning of year	2015-12-31	$108,107
Other income received	2015-12-31	$-4,461
Net income (gross income less expenses)	2015-12-31	$-4,461
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$108,107
2014 : FIRST STATE BANK SAVINGS INCENTIVE PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$5,877
Expenses. Total of all expenses incurred	2014-12-31	$397,383
Benefits paid (including direct rollovers)	2014-12-31	$397,383
Total plan assets at end of year	2014-12-31	$108,107
Total plan assets at beginning of year	2014-12-31	$499,613
Total contributions received or receivable from participants	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$5,877
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$-391,506
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$108,107
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$499,613
Total contributions received or receivable from employer(s)	2014-12-31	$0
2013 : FIRST STATE BANK SAVINGS INCENTIVE PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$5,000
Total income from all sources	2013-12-31	$119,612
Expenses. Total of all expenses incurred	2013-12-31	$45,416
Benefits paid (including direct rollovers)	2013-12-31	$45,416
Total plan assets at end of year	2013-12-31	$499,613
Total plan assets at beginning of year	2013-12-31	$420,417
Total contributions received or receivable from participants	2013-12-31	$24,225
Other income received	2013-12-31	$85,712
Net income (gross income less expenses)	2013-12-31	$74,196
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$499,613
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$420,417
Assets. Value of participant loans	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$9,675
Value of certain deemed distributions of participant loans	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
2012 : FIRST STATE BANK SAVINGS INCENTIVE PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$115,335
Expenses. Total of all expenses incurred	2012-12-31	$231,905
Benefits paid (including direct rollovers)	2012-12-31	$231,905
Total plan assets at end of year	2012-12-31	$420,417
Total plan assets at beginning of year	2012-12-31	$536,988
Value of fidelity bond covering the plan	2012-12-31	$335,000
Total contributions received or receivable from participants	2012-12-31	$35,725
Other income received	2012-12-31	$64,810
Net income (gross income less expenses)	2012-12-31	$-116,570
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$420,417
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$536,988
Total contributions received or receivable from employer(s)	2012-12-31	$14,800
2011 : FIRST STATE BANK SAVINGS INCENTIVE PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$18,384
Expenses. Total of all expenses incurred	2011-12-31	$44,676
Benefits paid (including direct rollovers)	2011-12-31	$44,676
Total plan assets at end of year	2011-12-31	$536,988
Total plan assets at beginning of year	2011-12-31	$563,280
Value of fidelity bond covering the plan	2011-12-31	$3,000,000
Total contributions received or receivable from participants	2011-12-31	$39,200
Other income received	2011-12-31	$-37,216
Net income (gross income less expenses)	2011-12-31	$-26,292
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$536,988
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$563,280
Total contributions received or receivable from employer(s)	2011-12-31	$16,400
2010 : FIRST STATE BANK SAVINGS INCENTIVE PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$116,489
Expenses. Total of all expenses incurred	2010-12-31	$10,617
Benefits paid (including direct rollovers)	2010-12-31	$10,617
Total plan assets at end of year	2010-12-31	$563,280
Total plan assets at beginning of year	2010-12-31	$457,408
Value of fidelity bond covering the plan	2010-12-31	$3,000,000
Total contributions received or receivable from participants	2010-12-31	$40,100
Other income received	2010-12-31	$60,171
Net income (gross income less expenses)	2010-12-31	$105,872
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$563,280
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$457,408
Total contributions received or receivable from employer(s)	2010-12-31	$16,218

Form 5500 Responses for FIRST STATE BANK SAVINGS INCENTIVE PLAN

2015: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	This submission is the final filing	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: FIRST STATE BANK SAVINGS INCENTIVE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	FIRST STATE BANK OF FAIRFAX
Employer identification number (EIN):	730242080
NAIC Classification:	522110
NAIC Description:	Commercial Banking