401k Plan data: AMICA DISCRETIONARY SUPPLEMENT PLAN plan

AMICA DISCRETIONARY SUPPLEMENT PLAN 401k Plan overview

Plan Name	AMICA DISCRETIONARY SUPPLEMENT PLAN
Plan identification number	508

AMICA DISCRETIONARY SUPPLEMENT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Other welfare benefit cover

401k Sponsoring company profile

AMICA MUTUAL INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name: AMICA MUTUAL INSURANCE COMPANY

Employer identification number (EIN): 050348344

NAIC Classification: 524150

Additional information about AMICA MUTUAL INSURANCE COMPANY

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 565037

More information about AMICA MUTUAL INSURANCE COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMICA DISCRETIONARY SUPPLEMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
508 2009-01-01 ROBERT K. MACKENZIE, VP, SECRETARY ROBERT K. MACKENZIE, VP, SECRETARY 2010-09-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
508	2009-01-01	ROBERT K. MACKENZIE, VP, SECRETARY		ROBERT K. MACKENZIE, VP, SECRETARY	2010-09-13

Plan Statistics for AMICA DISCRETIONARY SUPPLEMENT PLAN

401k plan membership statisitcs for AMICA DISCRETIONARY SUPPLEMENT PLAN

Measure Date Value
2009: AMICA DISCRETIONARY SUPPLEMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 579
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 0
Number of retired or separated participants receiving benefits 2009-01-01 622
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 622

Measure	Date	Value
2009: AMICA DISCRETIONARY SUPPLEMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	579
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	0
Number of retired or separated participants receiving benefits	2009-01-01	622
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	622

Financial Data on AMICA DISCRETIONARY SUPPLEMENT PLAN

Measure	Date	Value
2010 : AMICA DISCRETIONARY SUPPLEMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$0
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$0
Value of total assets at end of year	2010-12-31	$0
Value of total assets at beginning of year	2010-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$0
Total interest from all sources	2010-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Value of net income/loss	2010-12-31	$0
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$0

Form 5500 Responses for AMICA DISCRETIONARY SUPPLEMENT PLAN

2009: AMICA DISCRETIONARY SUPPLEMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	AMICA MUTUAL INSURANCE COMPANY
Employer identification number (EIN):	050348344
NAIC Classification:	524150

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	565037