401k Plan data: MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN plan

MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN 401k Plan overview

Plan Name	MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN
Plan identification number	506

MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MERCHANT & GOULD P.C. has sponsored the creation of one or more 401k plans.

Company Name: MERCHANT & GOULD P.C.

Employer identification number (EIN): 410991388

NAIC Classification: 541110
NAIC Description: Offices of Lawyers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2011-01-01 TRACEY SKJEVELAND TRACEY SKJEVELAND 2012-06-06
506 2010-01-01 TRACEY SKJEVELAND
506 2009-01-01 TRACEY R SKJEVELAND TRACEY R SKJEVELAND 2010-10-05

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
506	2011-01-01	TRACEY SKJEVELAND	TRACEY SKJEVELAND	2012-06-06
506	2010-01-01	TRACEY SKJEVELAND
506	2009-01-01	TRACEY R SKJEVELAND	TRACEY R SKJEVELAND	2010-10-05

Plan Statistics for MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN

401k plan membership statisitcs for MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN

Measure Date Value
2011: MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 0
2010: MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 186
Number of retired or separated participants receiving benefits 2010-01-01 2
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 188
2009: MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 238
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 200
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 200

Measure	Date	Value
2011: MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	0
2010: MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	186
Number of retired or separated participants receiving benefits	2010-01-01	2
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	188
2009: MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	238
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	200
Number of retired or separated participants receiving benefits	2009-01-01	0
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	200

Form 5500 Responses for MERCHANT AND GOULD P.C. LIFE INSURANCE PLAN

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

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Company Name:	MERCHANT & GOULD P.C.
Employer identification number (EIN):	410991388
NAIC Classification:	541110
NAIC Description:	Offices of Lawyers