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FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 401k Plan overview

Plan NameFIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN
Plan identification number 502

FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

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

Company Name:FIRST STATE BANK OF UVALDE
Employer identification number (EIN):740625760
NAIC Classification:522110
NAIC Description:Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-09-01PATTI KRUCIAK2023-12-21
5022021-09-01PATTI KRUCIAK2023-01-11
5022020-09-01PATTI KRUCIAK2022-02-17
5022019-09-01PATTI KRUCIAK2021-06-04
5022019-09-01PATTI KRUCIAK2022-02-17

Plan Statistics for FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN

401k plan membership statisitcs for FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN

Measure Date Value
2022: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2022 401k membership
Total participants, beginning-of-year2022-09-01105
Total number of active participants reported on line 7a of the Form 55002022-09-0191
Number of retired or separated participants receiving benefits2022-09-010
Number of other retired or separated participants entitled to future benefits2022-09-010
Total of all active and inactive participants2022-09-0191
Number of employers contributing to the scheme2022-09-010
2021: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-01100
Total number of active participants reported on line 7a of the Form 55002021-09-0193
Number of retired or separated participants receiving benefits2021-09-010
Number of other retired or separated participants entitled to future benefits2021-09-010
Total of all active and inactive participants2021-09-0193
Number of employers contributing to the scheme2021-09-010
2020: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-01100
Total number of active participants reported on line 7a of the Form 55002020-09-01100
Number of retired or separated participants receiving benefits2020-09-010
Number of other retired or separated participants entitled to future benefits2020-09-010
Total of all active and inactive participants2020-09-01100
Number of employers contributing to the scheme2020-09-010
2019: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01100
Total number of active participants reported on line 7a of the Form 55002019-09-0189
Number of retired or separated participants receiving benefits2019-09-010
Number of other retired or separated participants entitled to future benefits2019-09-010
Total of all active and inactive participants2019-09-0189
Number of employers contributing to the scheme2019-09-010

Form 5500 Responses for FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN

2022: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2022 form 5500 responses
2022-09-01Type of plan entitySingle employer plan
2022-09-01Plan funding arrangement – InsuranceYes
2022-09-01Plan benefit arrangement – InsuranceYes
2021: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – InsuranceYes
2020: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – InsuranceYes
2019: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01First time form 5500 has been submittedYes
2019-09-01Submission has been amendedYes
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number324700
Policy instance 1
Insurance contract or identification number324700
Number of Individuals Covered192
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $73,140
Total amount of fees paid to insurance companyUSD $1,668
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,229,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $73,140
Amount paid for insurance broker fees1668
Additional information about fees paid to insurance brokerOTHER COMMISSIONS, NON-MONETARY COMPENSATION
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-57118
Policy instance 2
Insurance contract or identification number010-57118
Number of Individuals Covered200
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $6,977
Total amount of fees paid to insurance companyUSD $518
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,977
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number324700
Policy instance 1
Insurance contract or identification number324700
Number of Individuals Covered209
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $78,060
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,357,421
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $78,060
Amount paid for insurance broker fees0
Insurance broker organization code?3
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number010-57118
Policy instance 2
Insurance contract or identification number010-57118
Number of Individuals Covered204
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $7,146
Total amount of fees paid to insurance companyUSD $1,786
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,146
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number918863
Policy instance 1
Insurance contract or identification number918863
Number of Individuals Covered234
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $6,726
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,574,147
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,171
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number918863
Policy instance 1
Insurance contract or identification number918863
Number of Individuals Covered208
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $6,373
Total amount of fees paid to insurance companyUSD $57,667
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,421,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,373
Amount paid for insurance broker fees57667
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3

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