401k Plan data: MERCHANTS BANK VISION plan

MERCHANTS BANK VISION 401k Plan overview

Plan Name	MERCHANTS BANK VISION
Plan identification number	506

MERCHANTS BANK VISION Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	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 VISION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2016-01-01 KIM BOYARSKY
506 2015-01-01 JACQUIE DRAGON
506 2014-01-01 JACQUIE DRAGON
506 2013-01-01 JACQUIE DRAGON

Plan id#	Filing Submission Date	Name of Administrator
506	2016-01-01	KIM BOYARSKY
506	2015-01-01	JACQUIE DRAGON
506	2014-01-01	JACQUIE DRAGON
506	2013-01-01	JACQUIE DRAGON

Plan Statistics for MERCHANTS BANK VISION

401k plan membership statisitcs for MERCHANTS BANK VISION

Measure Date Value
2016: MERCHANTS BANK VISION 2016 401k membership
Total participants, beginning-of-year 2016-01-01 236
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 234
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 2016-01-01 234
2015: MERCHANTS BANK VISION 2015 401k membership
Total participants, beginning-of-year 2015-01-01 236
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 236
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 2015-01-01 236
2014: MERCHANTS BANK VISION 2014 401k membership
Total participants, beginning-of-year 2014-01-01 254
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 254
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 2014-01-01 254
2013: MERCHANTS BANK VISION 2013 401k membership
Total participants, beginning-of-year 2013-01-01 237
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 237
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 2013-01-01 237

Measure	Date	Value
2016: MERCHANTS BANK VISION 2016 401k membership
Total participants, beginning-of-year	2016-01-01	236
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	234
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	234
2015: MERCHANTS BANK VISION 2015 401k membership
Total participants, beginning-of-year	2015-01-01	236
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	236
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	236
2014: MERCHANTS BANK VISION 2014 401k membership
Total participants, beginning-of-year	2014-01-01	254
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	254
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	254
2013: MERCHANTS BANK VISION 2013 401k membership
Total participants, beginning-of-year	2013-01-01	237
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	237
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	237

Form 5500 Responses for MERCHANTS BANK VISION

2016: MERCHANTS BANK VISION 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 VISION 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 VISION 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 VISION 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

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30023593

Policy instance

Insurance contract or identification number	30023593
Number of Individuals Covered	236
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,355
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,355
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3
Insurance broker name	NORTHERN BENEFITS,LTD

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30023593

Policy instance

Insurance contract or identification number	30023593
Number of Individuals Covered	254
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,324
Total amount of fees paid to insurance company	USD $1,324
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,324
Amount paid for insurance broker fees	1324
Additional information about fees paid to insurance broker	BROKER
Insurance broker organization code?	3
Insurance broker name

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30023593

Policy instance

Insurance contract or identification number	30023593
Number of Individuals Covered	237
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,300
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,300
Insurance broker organization code?	3
Insurance broker name	NORTHERN BENEFITS,LTD

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