401k Plan data: MBANK WELFARE BENEFIT PLAN plan

MBANK WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	MBANK WELFARE BENEFIT PLAN
Plan identification number	501

MBANK WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

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

Company Name: NICOLET NATIONAL BANK

Employer identification number (EIN): 380787825

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MBANK WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2013-01-01 LINDA BOLDA
501 2012-01-01 LINDA BOLDA
501 2011-01-01 LINDA BOLDA

Plan id#	Filing Submission Date	Name of Administrator
501	2013-01-01	LINDA BOLDA
501	2012-01-01	LINDA BOLDA
501	2011-01-01	LINDA BOLDA

Plan Statistics for MBANK WELFARE BENEFIT PLAN

401k plan membership statisitcs for MBANK WELFARE BENEFIT PLAN

Measure Date Value
2013: MBANK WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 125
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 2013-01-01 125
2012: MBANK WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 107
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 107
2011: MBANK WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 102
Total of all active and inactive participants 2011-01-01 102

Measure	Date	Value
2013: MBANK WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	125
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	125
2012: MBANK WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	107
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	107
2011: MBANK WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	102
Total of all active and inactive participants	2011-01-01	102

Form 5500 Responses for MBANK WELFARE BENEFIT PLAN

2013: MBANK WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
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: MBANK WELFARE BENEFIT 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: MBANK WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	NICOLET NATIONAL BANK
Employer identification number (EIN):	380787825
NAIC Classification:	522110
NAIC Description:	Commercial Banking