401k Plan data: GROUP LIFE PLAN plan

GROUP LIFE PLAN 401k Plan overview

Plan Name	GROUP LIFE PLAN
Plan identification number	512

GROUP LIFE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness)

401k Sponsoring company profile

VAN GILDER INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name: VAN GILDER INSURANCE COMPANY

Employer identification number (EIN): 840588917

NAIC Classification: 524210
NAIC Description: Insurance Agencies and Brokerages

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP LIFE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
512 2013-01-01 ED HARRINGTON ED HARRINGTON 2014-10-15
512 2012-01-01 ED HARRINGTON ED HARRINGTON 2013-08-14
512 2011-09-01 SHELLY JOHNSON
512 2010-09-01 SHELLY JOHNSON
512 2009-09-01 SHELLY JOHNSON

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
512	2013-01-01	ED HARRINGTON	ED HARRINGTON	2014-10-15
512	2012-01-01	ED HARRINGTON	ED HARRINGTON	2013-08-14
512	2011-09-01	SHELLY JOHNSON
512	2010-09-01	SHELLY JOHNSON
512	2009-09-01	SHELLY JOHNSON

Plan Statistics for GROUP LIFE PLAN

401k plan membership statisitcs for GROUP LIFE PLAN

Measure Date Value
2013: GROUP LIFE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 0
2012: GROUP LIFE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 122
Total of all active and inactive participants 2012-01-01 122
Total participants 2012-01-01 122
2011: GROUP LIFE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 123
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 117
Total of all active and inactive participants 2011-09-01 117
Total participants 2011-09-01 117
2010: GROUP LIFE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-09-01 136
Total number of active participants reported on line 7a of the Form 5500 2010-09-01 123
Total of all active and inactive participants 2010-09-01 123
Total participants 2010-09-01 123
2009: GROUP LIFE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-09-01 186
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 136
Total of all active and inactive participants 2009-09-01 136
Total participants 2009-09-01 136

Measure	Date	Value
2013: GROUP LIFE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	0
2012: GROUP LIFE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	122
Total of all active and inactive participants	2012-01-01	122
Total participants	2012-01-01	122
2011: GROUP LIFE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	123
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	117
Total of all active and inactive participants	2011-09-01	117
Total participants	2011-09-01	117
2010: GROUP LIFE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-09-01	136
Total number of active participants reported on line 7a of the Form 5500	2010-09-01	123
Total of all active and inactive participants	2010-09-01	123
Total participants	2010-09-01	123
2009: GROUP LIFE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-09-01	186
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	136
Total of all active and inactive participants	2009-09-01	136
Total participants	2009-09-01	136

Form 5500 Responses for GROUP LIFE PLAN

2013: GROUP LIFE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	Yes
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: GROUP LIFE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: GROUP LIFE PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes
2010: GROUP LIFE PLAN 2010 form 5500 responses
2010-09-01	Type of plan entity	Single employer plan
2010-09-01	Plan funding arrangement – Insurance	Yes
2010-09-01	Plan benefit arrangement – Insurance	Yes
2009: GROUP LIFE PLAN 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Plan funding arrangement – Insurance	Yes
2009-09-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	VAN GILDER INSURANCE COMPANY
Employer identification number (EIN):	840588917
NAIC Classification:	524210
NAIC Description:	Insurance Agencies and Brokerages