401k Plan data: MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN plan

MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN 401k Plan overview

Plan Name	MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN
Plan identification number	507

MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN Benefits

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

401k Sponsoring company profile

MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA has sponsored the creation of one or more 401k plans.

Company Name: MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA

Employer identification number (EIN): 561122874

NAIC Classification: 524150

Additional information about MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 995298

More information about MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2017-06-01 JASON SANDNER
507 2016-06-01 JASON SANDNER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
507	2017-06-01	JASON SANDNER
507	2016-06-01	JASON SANDNER

Plan Statistics for MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN

401k plan membership statisitcs for MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN

Measure Date Value
2017: MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN 2017 401k membership
Total participants, beginning-of-year 2017-06-01 127
Total number of active participants reported on line 7a of the Form 5500 2017-06-01 0
Total of all active and inactive participants 2017-06-01 0
2016: MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN 2016 401k membership
Total participants, beginning-of-year 2016-06-01 135
Total number of active participants reported on line 7a of the Form 5500 2016-06-01 127
Total of all active and inactive participants 2016-06-01 127

Measure	Date	Value
2017: MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN 2017 401k membership
Total participants, beginning-of-year	2017-06-01	127
Total number of active participants reported on line 7a of the Form 5500	2017-06-01	0
Total of all active and inactive participants	2017-06-01	0
2016: MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	135
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	127
Total of all active and inactive participants	2016-06-01	127

Form 5500 Responses for MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN

2017: MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN 2017 form 5500 responses
2017-06-01	Type of plan entity	Single employer plan
2017-06-01	Submission has been amended	No
2017-06-01	This submission is the final filing	Yes
2017-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-06-01	Plan is a collectively bargained plan	No
2017-06-01	Plan funding arrangement – Insurance	Yes
2017-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-06-01	Plan benefit arrangement – Insurance	Yes
2017-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA VISION PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	First time form 5500 has been submitted	Yes
2016-06-01	Submission has been amended	No
2016-06-01	This submission is the final filing	No
2016-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-06-01	Plan is a collectively bargained plan	No
2016-06-01	Plan funding arrangement – Insurance	Yes
2016-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-06-01	Plan benefit arrangement – Insurance	Yes
2016-06-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )

Policy contract number

V65936

Policy instance

Insurance contract or identification number	V65936
Number of Individuals Covered	259
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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

Potentially related plans

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Company Name:	MEDICAL MUTUAL INSURANCE COMPANY OF NORTH CAROLINA
Employer identification number (EIN):	561122874
NAIC Classification:	524150

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	995298