FIRST STATE BANK OF ST. CHARLES HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

FIRST STATE BANK OF ST. CHARLES HEALTH AND WELFARE BENEFITS PLAN Benefits

401k Sponsoring company profile

Company Name:	FIRST STATE BANK OF ST. CHARLES
Employer identification number (EIN):	430492450
NAIC Classification:	522120
NAIC Description:	Savings Institutions

Form 5500 Filing Information

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2022-01-01
504	2021-01-01
504	2020-01-01

Plan Statistics for FIRST STATE BANK OF ST. CHARLES HEALTH AND WELFARE BENEFITS PLAN

Measure	Date	Value
2022: FIRST STATE BANK OF ST. CHARLES HEALTH AND WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	224
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	194
Number of retired or separated participants receiving benefits	2022-01-01	2
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	196
2021: FIRST STATE BANK OF ST. CHARLES HEALTH AND WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	212
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	224
Number of retired or separated participants receiving benefits	2021-01-01	1
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	225
2020: FIRST STATE BANK OF ST. CHARLES HEALTH AND WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	175
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	175

Form 5500 Responses for FIRST STATE BANK OF ST. CHARLES HEALTH AND WELFARE BENEFITS PLAN

Insurance Providers Used on plan

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• FIRST STATE CORPORATION 401(K) PLAN [EIN = 510266307]
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• FIRST STATE BANK 401(K) PLAN [EIN = 740730847]
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• FIRST STATE BANK OF SHELTON, NE PENSION PLAN [EIN = 470162810]
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• 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]
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• FIRST STATE BANK OF UVALDE 401(K) PLAN [EIN = 740625760]
• FIRST STATE BANK OMAHA 401(K) P/S PLAN [EIN = 470162740]
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• FIRST STATE BANK, CLUTE EMPLOYEE SAVINGS PLAN [EIN = 741311733]
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