| Plan Name | FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | FIRST STATE BANK OF UVALDE |
| Employer identification number (EIN): | 740625760 |
| NAIC Classification: | 522110 |
| NAIC Description: | Commercial Banking |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2023-09-01 | PATTI KRUCIAK | 2025-01-09 | ||
| 502 | 2022-09-01 | PATTI KRUCIAK | 2023-12-21 | ||
| 502 | 2021-09-01 | PATTI KRUCIAK | 2023-01-11 | ||
| 502 | 2020-09-01 | PATTI KRUCIAK | 2022-02-17 | ||
| 502 | 2019-09-01 | PATTI KRUCIAK | 2021-06-04 | ||
| 502 | 2019-09-01 | PATTI KRUCIAK | 2022-02-17 |
| 2023: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-09-01 | Type of plan entity | Single employer plan |
| 2023-09-01 | Plan funding arrangement – Insurance | Yes |
| 2023-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2022 form 5500 responses | ||
| 2022-09-01 | Type of plan entity | Single employer plan |
| 2022-09-01 | Plan funding arrangement – Insurance | Yes |
| 2022-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2021 form 5500 responses | ||
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Plan funding arrangement – Insurance | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2020 form 5500 responses | ||
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: FIRST STATE BANK OF UVALDE LIFE AND AD&D PLAN 2019 form 5500 responses | ||
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | First time form 5500 has been submitted | Yes |
| 2019-09-01 | Submission has been amended | Yes |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |||||||||||||||||||||
| Policy contract number | 324700 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| |||||||||||||||||||||
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||
| Policy contract number | GUVC0BL9X | ||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||
| |||||||||||||||||||||
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |||||||||||||||||||||
| Policy contract number | 324700 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |||||||||||||||||||||
| Policy contract number | 010-57118 | ||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |||||||||||||||||||||
| Policy contract number | 324700 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 ) | |||||||||||||||||||||
| Policy contract number | 010-57118 | ||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||
| Policy contract number | 918863 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||
| Policy contract number | 918863 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||