401k Plan data: HEARTLAND BANK GROUP MEDICAL INSURANCE plan

HEARTLAND BANK GROUP MEDICAL INSURANCE 401k Plan overview

Plan Name	HEARTLAND BANK GROUP MEDICAL INSURANCE
Plan identification number	503

HEARTLAND BANK GROUP MEDICAL INSURANCE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Vision Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: HEARTLAND BANK

Employer identification number (EIN): 430254257

NAIC Classification: 522120
NAIC Description: Savings Institutions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEARTLAND BANK GROUP MEDICAL INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2013-08-01 HERB ROACH
503 2012-08-01 HERB ROACH HERB ROACH 2014-05-15
503 2011-08-01 HERB ROACH HERB ROACH 2013-04-29
503 2009-08-01 HERB ROACH HERB ROACH 2011-05-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2013-08-01	HERB ROACH
503	2012-08-01	HERB ROACH	HERB ROACH	2014-05-15
503	2011-08-01	HERB ROACH	HERB ROACH	2013-04-29
503	2009-08-01	HERB ROACH	HERB ROACH	2011-05-13

Plan Statistics for HEARTLAND BANK GROUP MEDICAL INSURANCE

401k plan membership statisitcs for HEARTLAND BANK GROUP MEDICAL INSURANCE

Measure Date Value
2013: HEARTLAND BANK GROUP MEDICAL INSURANCE 2013 401k membership
Total participants, beginning-of-year 2013-08-01 1,527
Total number of active participants reported on line 7a of the Form 5500 2013-08-01 352
Number of retired or separated participants receiving benefits 2013-08-01 0
Number of other retired or separated participants entitled to future benefits 2013-08-01 0
Total of all active and inactive participants 2013-08-01 352
2012: HEARTLAND BANK GROUP MEDICAL INSURANCE 2012 401k membership
Total participants, beginning-of-year 2012-08-01 1,759
Total number of active participants reported on line 7a of the Form 5500 2012-08-01 1,527
Total of all active and inactive participants 2012-08-01 1,527
2011: HEARTLAND BANK GROUP MEDICAL INSURANCE 2011 401k membership
Total participants, beginning-of-year 2011-08-01 1,372
Total number of active participants reported on line 7a of the Form 5500 2011-08-01 1,751
Number of retired or separated participants receiving benefits 2011-08-01 8
Total of all active and inactive participants 2011-08-01 1,759
2009: HEARTLAND BANK GROUP MEDICAL INSURANCE 2009 401k membership
Total participants, beginning-of-year 2009-08-01 652
Total number of active participants reported on line 7a of the Form 5500 2009-08-01 777
Number of retired or separated participants receiving benefits 2009-08-01 8
Total of all active and inactive participants 2009-08-01 785
Total participants 2009-08-01 0

Measure	Date	Value
2013: HEARTLAND BANK GROUP MEDICAL INSURANCE 2013 401k membership
Total participants, beginning-of-year	2013-08-01	1,527
Total number of active participants reported on line 7a of the Form 5500	2013-08-01	352
Number of retired or separated participants receiving benefits	2013-08-01	0
Number of other retired or separated participants entitled to future benefits	2013-08-01	0
Total of all active and inactive participants	2013-08-01	352
2012: HEARTLAND BANK GROUP MEDICAL INSURANCE 2012 401k membership
Total participants, beginning-of-year	2012-08-01	1,759
Total number of active participants reported on line 7a of the Form 5500	2012-08-01	1,527
Total of all active and inactive participants	2012-08-01	1,527
2011: HEARTLAND BANK GROUP MEDICAL INSURANCE 2011 401k membership
Total participants, beginning-of-year	2011-08-01	1,372
Total number of active participants reported on line 7a of the Form 5500	2011-08-01	1,751
Number of retired or separated participants receiving benefits	2011-08-01	8
Total of all active and inactive participants	2011-08-01	1,759
2009: HEARTLAND BANK GROUP MEDICAL INSURANCE 2009 401k membership
Total participants, beginning-of-year	2009-08-01	652
Total number of active participants reported on line 7a of the Form 5500	2009-08-01	777
Number of retired or separated participants receiving benefits	2009-08-01	8
Total of all active and inactive participants	2009-08-01	785
Total participants	2009-08-01	0

Form 5500 Responses for HEARTLAND BANK GROUP MEDICAL INSURANCE

2013: HEARTLAND BANK GROUP MEDICAL INSURANCE 2013 form 5500 responses
2013-08-01	Type of plan entity	Single employer plan
2013-08-01	Submission has been amended	No
2013-08-01	This submission is the final filing	No
2013-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-08-01	Plan is a collectively bargained plan	No
2013-08-01	Plan funding arrangement – Insurance	Yes
2013-08-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-08-01	Plan benefit arrangement – Insurance	Yes
2013-08-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: HEARTLAND BANK GROUP MEDICAL INSURANCE 2012 form 5500 responses
2012-08-01	Type of plan entity	Single employer plan
2012-08-01	Submission has been amended	No
2012-08-01	This submission is the final filing	No
2012-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-08-01	Plan is a collectively bargained plan	No
2012-08-01	Plan funding arrangement – Insurance	Yes
2012-08-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-08-01	Plan benefit arrangement – Insurance	Yes
2012-08-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: HEARTLAND BANK GROUP MEDICAL INSURANCE 2011 form 5500 responses
2011-08-01	Type of plan entity	Single employer plan
2011-08-01	Submission has been amended	No
2011-08-01	This submission is the final filing	No
2011-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-08-01	Plan is a collectively bargained plan	No
2011-08-01	Plan funding arrangement – Insurance	Yes
2011-08-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-08-01	Plan benefit arrangement – Insurance	Yes
2011-08-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: HEARTLAND BANK GROUP MEDICAL INSURANCE 2009 form 5500 responses
2009-08-01	Type of plan entity	Single employer plan
2009-08-01	Submission has been amended	No
2009-08-01	This submission is the final filing	No
2009-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-08-01	Plan is a collectively bargained plan	No
2009-08-01	Plan funding arrangement – Insurance	Yes
2009-08-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	HEARTLAND BANK
Employer identification number (EIN):	430254257
NAIC Classification:	522120
NAIC Description:	Savings Institutions