401k Plan data: WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN plan

WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN 401k Plan overview

Plan Name	WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN
Plan identification number	503

WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

WOOD COUNTY TELEPHONE COMPANY has sponsored the creation of one or more 401k plans.

Company Name: WOOD COUNTY TELEPHONE COMPANY

Employer identification number (EIN): 390720490

NAIC Classification: 517000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2012-09-01 DOUGLAS WENZLAFF
503 2011-09-01 DOUGLAS WENZLAFF

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2012-09-01	DOUGLAS WENZLAFF
503	2011-09-01	DOUGLAS WENZLAFF

Plan Statistics for WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN

401k plan membership statisitcs for WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN

Measure Date Value
2012: WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 99
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 94
Number of retired or separated participants receiving benefits 2012-09-01 0
Number of other retired or separated participants entitled to future benefits 2012-09-01 0
Total of all active and inactive participants 2012-09-01 94
2011: WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 99
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 100
Number of retired or separated participants receiving benefits 2011-09-01 0
Number of other retired or separated participants entitled to future benefits 2011-09-01 0
Total of all active and inactive participants 2011-09-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-09-01 0

Measure	Date	Value
2012: WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	99
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	94
Number of retired or separated participants receiving benefits	2012-09-01	0
Number of other retired or separated participants entitled to future benefits	2012-09-01	0
Total of all active and inactive participants	2012-09-01	94
2011: WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	99
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	100
Number of retired or separated participants receiving benefits	2011-09-01	0
Number of other retired or separated participants entitled to future benefits	2011-09-01	0
Total of all active and inactive participants	2011-09-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-09-01	0

Form 5500 Responses for WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN

2012: WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Submission has been amended	No
2012-09-01	This submission is the final filing	No
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	No
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2011: WOOD COUNTY TELEPHONE COMPANY TERM LIFE INSURANCE PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	First time form 5500 has been submitted	Yes
2011-09-01	Submission has been amended	No
2011-09-01	This submission is the final filing	No
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-09-01	Plan is a collectively bargained plan	No
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00416671

Policy instance

Insurance contract or identification number	00416671
Number of Individuals Covered	94
Insurance policy start date	2012-09-01
Insurance policy end date	2013-08-31
Total amount of commissions paid to insurance broker	USD $6,754
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	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $44,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,720
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	GREAT LAKES INS CONSULTANTS, INC.

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00416671

Policy instance

Insurance contract or identification number	00416671
Number of Individuals Covered	99
Insurance policy start date	2011-09-01
Insurance policy end date	2012-08-31
Total amount of commissions paid to insurance broker	USD $6,498
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	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $43,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	WOOD COUNTY TELEPHONE COMPANY
Employer identification number (EIN):	390720490
NAIC Classification:	517000