401k Plan data: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN plan

BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN
Plan identification number	001

BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
Covered by PBGC - Plan is covered under the PBGC insurance program (see ERISA section 4021).
Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
ESOP other than a leveraged ESOP - A completed Schedule E must be attached to a Form 5500 filed for an Employee Stock Ownership Plan (ESOP).
Leveraged ESOP - An ESOP that acquires employer securities with borrowed money or other debt-financing techniques. A completed Schedule E must be attached to a Form 5500 filed for an ESOP.
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

BUCKEYE STATE BANK has sponsored the creation of one or more 401k plans.

Company Name: BUCKEYE STATE BANK

Employer identification number (EIN): 344204810

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01 DON FOSTER 2016-09-13
001 2014-01-01 PHILIP W. KINLEY 2015-05-19
001 2013-10-01 PHIL KINLEY
001 2012-10-01 MICHAEL CONRAD
001 2011-10-01 MICHAEL L. WALLACE
001 2009-10-01 MICHAEL L. WALLACE

Plan Statistics for BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN

Measure Date Value
2018: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 27
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 23
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 14
Total of all active and inactive participants 2018-01-01 37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 37
Number of participants with account balances 2018-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 27
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 18
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 9
Total of all active and inactive participants 2017-01-01 27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 27
Number of participants with account balances 2017-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 19
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 8
Total of all active and inactive participants 2016-01-01 27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 27
Number of participants with account balances 2016-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2013: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 6
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 0
Number of retired or separated participants receiving benefits 2013-10-01 0
Number of other retired or separated participants entitled to future benefits 2013-10-01 0
Total of all active and inactive participants 2013-10-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-10-01 0
Total participants 2013-10-01 0
2012: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 7
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 6
Number of retired or separated participants receiving benefits 2012-10-01 0
Number of other retired or separated participants entitled to future benefits 2012-10-01 0
Total of all active and inactive participants 2012-10-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-10-01 0
Total participants 2012-10-01 6
2011: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 9
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 7
Number of retired or separated participants receiving benefits 2011-10-01 0
Number of other retired or separated participants entitled to future benefits 2011-10-01 1
Total of all active and inactive participants 2011-10-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-10-01 0
Total participants 2011-10-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 0
2009: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 11
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 9
Number of retired or separated participants receiving benefits 2009-10-01 0
Number of other retired or separated participants entitled to future benefits 2009-10-01 0
Total of all active and inactive participants 2009-10-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-10-01 0
Total participants 2009-10-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-10-01 0

Measure	Date	Value
2018: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	23
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	14
Total of all active and inactive participants	2018-01-01	37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	37
Number of participants with account balances	2018-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	18
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	9
Total of all active and inactive participants	2017-01-01	27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	27
Number of participants with account balances	2017-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	19
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	8
Total of all active and inactive participants	2016-01-01	27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	27
Number of participants with account balances	2016-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2013: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	6
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	0
Number of retired or separated participants receiving benefits	2013-10-01	0
Number of other retired or separated participants entitled to future benefits	2013-10-01	0
Total of all active and inactive participants	2013-10-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-10-01	0
Total participants	2013-10-01	0
2012: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	7
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	6
Number of retired or separated participants receiving benefits	2012-10-01	0
Number of other retired or separated participants entitled to future benefits	2012-10-01	0
Total of all active and inactive participants	2012-10-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-10-01	0
Total participants	2012-10-01	6
2011: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	9
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	7
Number of retired or separated participants receiving benefits	2011-10-01	0
Number of other retired or separated participants entitled to future benefits	2011-10-01	1
Total of all active and inactive participants	2011-10-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-10-01	0
Total participants	2011-10-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	0
2009: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	11
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	9
Number of retired or separated participants receiving benefits	2009-10-01	0
Number of other retired or separated participants entitled to future benefits	2009-10-01	0
Total of all active and inactive participants	2009-10-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-10-01	0
Total participants	2009-10-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-10-01	0

Financial Data on BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2018 : BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$298,079
Expenses. Total of all expenses incurred	2018-12-31	$59,898
Benefits paid (including direct rollovers)	2018-12-31	$58,803
Total plan assets at end of year	2018-12-31	$564,011
Total plan assets at beginning of year	2018-12-31	$325,830
Value of fidelity bond covering the plan	2018-12-31	$1,500,000
Total contributions received or receivable from participants	2018-12-31	$57,239
Contributions received from other sources (not participants or employers)	2018-12-31	$66,178
Other income received	2018-12-31	$28,572
Net income (gross income less expenses)	2018-12-31	$238,181
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$564,011
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$325,830
Assets. Value of employer securities	2018-12-31	$367,546
Total contributions received or receivable from employer(s)	2018-12-31	$146,090
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$1,095
2017 : BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2017 401k financial data
Transfers to/from the plan	2017-12-31	$0
Total income from all sources	2017-12-31	$178,300
Expenses. Total of all expenses incurred	2017-12-31	$42,359
Benefits paid (including direct rollovers)	2017-12-31	$41,486
Total plan assets at end of year	2017-12-31	$325,830
Total plan assets at beginning of year	2017-12-31	$189,889
Value of fidelity bond covering the plan	2017-12-31	$1,500,000
Total contributions received or receivable from participants	2017-12-31	$41,061
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$23,544
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$135,941
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$325,830
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$189,889
Assets. Value of employer securities	2017-12-31	$150,231
Total contributions received or receivable from employer(s)	2017-12-31	$113,695
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$873
2016 : BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total income from all sources	2016-12-31	$93,549
Expenses. Total of all expenses incurred	2016-12-31	$15,718
Benefits paid (including direct rollovers)	2016-12-31	$15,021
Total plan assets at end of year	2016-12-31	$189,889
Total plan assets at beginning of year	2016-12-31	$112,058
Value of fidelity bond covering the plan	2016-12-31	$1,500,000
Total contributions received or receivable from participants	2016-12-31	$60,451
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$5,113
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$77,831
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$189,889
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$112,058
Assets. Value of employer securities	2016-12-31	$15,039
Total contributions received or receivable from employer(s)	2016-12-31	$27,985
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$697
2013 : BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-09-30	$0
Funding deficiency by the employer to the plan for this plan year	2013-09-30	$0
Minimum employer required contribution for this plan year	2013-09-30	$0
Amount contributed by the employer to the plan for this plan year	2013-09-30	$0
2012 : BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-09-30	$0
Funding deficiency by the employer to the plan for this plan year	2012-09-30	$0
Minimum employer required contribution for this plan year	2012-09-30	$0
Amount contributed by the employer to the plan for this plan year	2012-09-30	$0
2011 : BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-09-30	$0
Funding deficiency by the employer to the plan for this plan year	2011-09-30	$0
Minimum employer required contribution for this plan year	2011-09-30	$0
Amount contributed by the employer to the plan for this plan year	2011-09-30	$0
2010 : BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-09-30	$0
Funding deficiency by the employer to the plan for this plan year	2010-09-30	$0
Minimum employer required contribution for this plan year	2010-09-30	$0
Amount contributed by the employer to the plan for this plan year	2010-09-30	$0

Form 5500 Responses for BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN

2018: BUCKEYE STATE BANK 401(K) PROFIT SHARING 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: BUCKEYE STATE BANK 401(K) PROFIT SHARING 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: BUCKEYE STATE BANK 401(K) PROFIT SHARING 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
2013: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	This submission is the final filing	Yes
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-10-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2013-10-01	Plan benefit arrangement – Section 412(e)(3) insurance Contracts	Yes
2012: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2012-10-01	Plan benefit arrangement – Section 412(e)(3) insurance Contracts	Yes
2011: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2011-10-01	Plan benefit arrangement – Section 412(e)(3) insurance Contracts	Yes
2009: BUCKEYE STATE BANK 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2009-10-01	Plan benefit arrangement – Section 412(e)(3) insurance Contracts	Yes

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

E658881

Policy instance

Insurance contract or identification number	E658881
Number of Individuals Covered	37
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $130
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $130
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	WHOLESALER SERVICE
Insurance broker organization code?	0

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )

Policy contract number

632012

Policy instance

Insurance contract or identification number	632012
Number of Individuals Covered	21
Insurance policy start date	2018-01-01
Insurance policy end date	2018-05-04
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $102
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	85
Additional information about fees paid to insurance broker	WHOLESALER SERVICE
Insurance broker organization code?	0

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )

Policy contract number

632012

Policy instance

Insurance contract or identification number	632012
Number of Individuals Covered	17
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 $211
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	165
Additional information about fees paid to insurance broker	WHOLESALER SERVICE
Insurance broker organization code?	3
Insurance broker name	SWBC INVESTMENT ADVISORY SERVICES

TRANSAMERICA LIFE INSURANCE ANNUITY (National Association of Insurance Commissioners NAIC id number: 69507 )

Policy contract number

0020000399

Policy instance

Insurance contract or identification number	0020000399
Number of Individuals Covered	6
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $1,513
Commission paid to Insurance Broker	USD $1,513
Insurance broker organization code?	3
Insurance broker name	RMG FINANCIAL GROUP

TRANSAMERICA LIFE INSURANCE ANNUITY (National Association of Insurance Commissioners NAIC id number: 69507 )

Policy contract number

0020000399

Policy instance

Insurance contract or identification number	0020000399
Number of Individuals Covered	8
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30

TRANSAMERICA LIFE INSURANCE ANNUITY (National Association of Insurance Commissioners NAIC id number: 69507 )

Policy contract number

0020000399

Policy instance

Insurance contract or identification number	0020000399
Number of Individuals Covered	8
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $1,690

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Company Name:	BUCKEYE STATE BANK
Employer identification number (EIN):	344204810
NAIC Classification:	522110
NAIC Description:	Commercial Banking