401k Plan data: R BANK TEXAS MEDICAL BENEFIT PLAN plan

R BANK TEXAS MEDICAL BENEFIT PLAN 401k Plan overview

Plan Name	R BANK TEXAS MEDICAL BENEFIT PLAN
Plan identification number	503

R BANK TEXAS MEDICAL BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

R BANK TEXAS has sponsored the creation of one or more 401k plans.

Company Name: R BANK TEXAS

Employer identification number (EIN): 264536354

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan R BANK TEXAS MEDICAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2020-10-01 KARA GARRETT 2022-07-12
503 2019-10-01 KARA GARRETT 2021-07-16
503 2019-10-01 KARA GARRETT 2021-07-16
503 2019-10-01 KARA GARRETT 2021-07-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2020-10-01	KARA GARRETT	2022-07-12
503	2019-10-01	KARA GARRETT	2021-07-16
503	2019-10-01	KARA GARRETT	2021-07-16
503	2019-10-01	KARA GARRETT	2021-07-16

Plan Statistics for R BANK TEXAS MEDICAL BENEFIT PLAN

401k plan membership statisitcs for R BANK TEXAS MEDICAL BENEFIT PLAN

Measure Date Value
2020: R BANK TEXAS MEDICAL BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 118
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 122
Number of retired or separated participants receiving benefits 2020-10-01 29
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 151
2019: R BANK TEXAS MEDICAL BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 118
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 126
Number of retired or separated participants receiving benefits 2019-10-01 12
Number of other retired or separated participants entitled to future benefits 2019-10-01 0
Total of all active and inactive participants 2019-10-01 138

Measure	Date	Value
2020: R BANK TEXAS MEDICAL BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	118
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	122
Number of retired or separated participants receiving benefits	2020-10-01	29
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	151
2019: R BANK TEXAS MEDICAL BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	118
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	126
Number of retired or separated participants receiving benefits	2019-10-01	12
Number of other retired or separated participants entitled to future benefits	2019-10-01	0
Total of all active and inactive participants	2019-10-01	138

Form 5500 Responses for R BANK TEXAS MEDICAL BENEFIT PLAN

2020: R BANK TEXAS MEDICAL BENEFIT PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Submission has been amended	No
2020-10-01	This submission is the final filing	No
2020-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-10-01	Plan is a collectively bargained plan	No
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2019: R BANK TEXAS MEDICAL BENEFIT PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	First time form 5500 has been submitted	Yes
2019-10-01	Submission has been amended	No
2019-10-01	This submission is the final filing	No
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-10-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

05W8996

Policy instance

Insurance contract or identification number	05W8996
Number of Individuals Covered	206
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $43,429
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $865,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,670
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

5W8998

Policy instance

Insurance contract or identification number	5W8998
Number of Individuals Covered	200
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $28,022
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $831,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,261
Insurance broker organization code?	3

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Company Name:	R BANK TEXAS
Employer identification number (EIN):	264536354
NAIC Classification:	522110
NAIC Description:	Commercial Banking