401k Plan data: MERCHANTS BANK GROUP MEDICAL PLAN plan

MERCHANTS BANK GROUP MEDICAL PLAN 401k Plan overview

Plan Name	MERCHANTS BANK GROUP MEDICAL PLAN
Plan identification number	501

MERCHANTS BANK GROUP MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Vision

401k Sponsoring company profile

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

Company Name: THE MERCHANTS BANK

Employer identification number (EIN): 030141230

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MERCHANTS BANK GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01 KIM BOYARSKY
501 2015-01-01 JACQUIE DRAGON
501 2014-01-01 JACQUIE DRAGON
501 2013-01-01 JACQUIE DRAGON
501 2012-01-01 JACQUIE DRAGON
501 2011-07-01 CYNTHIA OLSON
501 2010-07-01 CYNTHIA OLSON FBO MERCHANTS BANK CYNTHIA OLSON FBO MERCHANTS BANK 2012-01-27
501 2009-07-01 CYNTHIA OLSON CYNTHIA OLSON 2011-01-26

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2016-01-01	KIM BOYARSKY
501	2015-01-01	JACQUIE DRAGON
501	2014-01-01	JACQUIE DRAGON
501	2013-01-01	JACQUIE DRAGON
501	2012-01-01	JACQUIE DRAGON
501	2011-07-01	CYNTHIA OLSON
501	2010-07-01	CYNTHIA OLSON FBO MERCHANTS BANK	CYNTHIA OLSON FBO MERCHANTS BANK	2012-01-27
501	2009-07-01	CYNTHIA OLSON	CYNTHIA OLSON	2011-01-26

Plan Statistics for MERCHANTS BANK GROUP MEDICAL PLAN

401k plan membership statisitcs for MERCHANTS BANK GROUP MEDICAL PLAN

Measure Date Value
2016: MERCHANTS BANK GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 201
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 185
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 185
2015: MERCHANTS BANK GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 201
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 201
2014: MERCHANTS BANK GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 216
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 216
2013: MERCHANTS BANK GROUP MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 203
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 202
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 2013-01-01 202
2012: MERCHANTS BANK GROUP MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 221
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 203
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 2012-01-01 203
2011: MERCHANTS BANK GROUP MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 235
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 219
Number of retired or separated participants receiving benefits 2011-07-01 2
Number of other retired or separated participants entitled to future benefits 2011-07-01 0
Total of all active and inactive participants 2011-07-01 221
2010: MERCHANTS BANK GROUP MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 246
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 228
Number of retired or separated participants receiving benefits 2010-07-01 7
Total of all active and inactive participants 2010-07-01 235
2009: MERCHANTS BANK GROUP MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 250
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 238
Number of retired or separated participants receiving benefits 2009-07-01 8
Total of all active and inactive participants 2009-07-01 246

Measure	Date	Value
2016: MERCHANTS BANK GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	201
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	185
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	185
2015: MERCHANTS BANK GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	201
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	201
2014: MERCHANTS BANK GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	216
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	216
2013: MERCHANTS BANK GROUP MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	203
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	202
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	202
2012: MERCHANTS BANK GROUP MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	221
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	203
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	203
2011: MERCHANTS BANK GROUP MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	235
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	219
Number of retired or separated participants receiving benefits	2011-07-01	2
Number of other retired or separated participants entitled to future benefits	2011-07-01	0
Total of all active and inactive participants	2011-07-01	221
2010: MERCHANTS BANK GROUP MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	246
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	228
Number of retired or separated participants receiving benefits	2010-07-01	7
Total of all active and inactive participants	2010-07-01	235
2009: MERCHANTS BANK GROUP MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	250
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	238
Number of retired or separated participants receiving benefits	2009-07-01	8
Total of all active and inactive participants	2009-07-01	246

Form 5500 Responses for MERCHANTS BANK GROUP MEDICAL PLAN

2016: MERCHANTS BANK GROUP MEDICAL PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MERCHANTS BANK GROUP MEDICAL PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MERCHANTS BANK GROUP MEDICAL PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MERCHANTS BANK GROUP MEDICAL 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: MERCHANTS BANK GROUP MEDICAL PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
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: MERCHANTS BANK GROUP MEDICAL PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	No
2011-07-01	This submission is the final filing	No
2011-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2011-07-01	Plan is a collectively bargained plan	No
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2010: MERCHANTS BANK GROUP MEDICAL PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2009: MERCHANTS BANK GROUP MEDICAL PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	This submission is the final filing	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	THE MERCHANTS BANK
Employer identification number (EIN):	030141230
NAIC Classification:	522110
NAIC Description:	Commercial Banking