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THE BANK OF MAINE GROUP EMPLOYEE MEDICAL PLAN 401k Plan overview

Plan NameTHE BANK OF MAINE GROUP EMPLOYEE MEDICAL PLAN
Plan identification number 503

THE BANK OF MAINE GROUP EMPLOYEE MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

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

Company Name:THE BANK OF MAINE
Employer identification number (EIN):010074920
NAIC Classification:522120
NAIC Description:Savings Institutions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE BANK OF MAINE GROUP EMPLOYEE MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032015-07-01MICHELLE LOVE MICHELLE LOVE2016-04-15
5032014-07-01MICHELLE LOVE MICHELLE LOVE2016-04-15
5032013-07-01ALLISON PEDERSON ALLISON PEDERSON2015-01-29
5032012-07-01ALLISON PEDERSON ALLISON PEDERSON2014-01-27
5032011-07-01ALLISON PEDERSON ALLISON PEDERSON2013-01-16
5032009-07-01ALLISON PEDERSON ALLISON PEDERSON2011-01-27

Plan Statistics for THE BANK OF MAINE GROUP EMPLOYEE MEDICAL PLAN

401k plan membership statisitcs for THE BANK OF MAINE GROUP EMPLOYEE MEDICAL PLAN

Measure Date Value
2015
Total participants, beginning-of-year2015-07-01223
Total number of active participants reported on line 7a of the Form 55002015-07-010
Total of all active and inactive participants2015-07-010
2014
Total participants, beginning-of-year2014-07-01239
Total number of active participants reported on line 7a of the Form 55002014-07-01213
Number of retired or separated participants receiving benefits2014-07-017
Total of all active and inactive participants2014-07-01220
2013
Total participants, beginning-of-year2013-07-01218
Total number of active participants reported on line 7a of the Form 55002013-07-01175
Number of retired or separated participants receiving benefits2013-07-0111
Total of all active and inactive participants2013-07-01186
2012
Total participants, beginning-of-year2012-07-01244
Total number of active participants reported on line 7a of the Form 55002012-07-01210
Number of retired or separated participants receiving benefits2012-07-0111
Total of all active and inactive participants2012-07-01221
2011
Total participants, beginning-of-year2011-07-01192
Total number of active participants reported on line 7a of the Form 55002011-07-01231
Number of retired or separated participants receiving benefits2011-07-0115
Total of all active and inactive participants2011-07-01246
2009
Total participants, beginning-of-year2009-07-01192
Total number of active participants reported on line 7a of the Form 55002009-07-01182
Number of retired or separated participants receiving benefits2009-07-019
Total of all active and inactive participants2009-07-01191

Form 5500 Responses

2015
2015-07-01Type of plan entitySingle employer plan
2015-07-01This submission is the final filingYes
2015-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes
2014
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – General assets of the sponsorYes
2013
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – General assets of the sponsorYes
2012
2012-07-01Type of plan entitySingle employer plan
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – General assets of the sponsorYes
2011
2011-07-01Type of plan entitySingle employer plan
2011-07-01Plan funding arrangement – General assets of the sponsorYes
2011-07-01Plan benefit arrangement – General assets of the sponsorYes
2009
2009-07-01Type of plan entitySingle employer plan
2009-07-01This submission is the final filingNo
2009-07-01Plan funding arrangement – General assets of the sponsorYes
2009-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number24582
Policy instance 1
Insurance contract or identification number24582
Number of Individuals Covered189
Insurance policy start date2015-07-01
Insurance policy end date2015-10-16
Total amount of commissions paid to insurance brokerUSD $3,155
Total amount of fees paid to insurance companyUSD $24
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $40,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,035
Insurance broker organization code?3
Amount paid for insurance broker fees24
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL30612
Policy instance 2
Insurance contract or identification numberHCL30612
Number of Individuals Covered238
Insurance policy start date2015-07-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,311
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,311
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203346
Policy instance 3
Insurance contract or identification numberVAR 203346
Number of Individuals Covered20
Insurance policy start date2015-07-01
Insurance policy end date2015-10-31
Total amount of commissions paid to insurance brokerUSD $37
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37
Insurance broker organization code?3
Insurance broker nameHEALY & ASSOCIATES, INC.
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30042695
Policy instance 4
Insurance contract or identification number30042695
Number of Individuals Covered0
Insurance policy start date2015-07-01
Insurance policy end date2015-11-01
Total amount of commissions paid to insurance brokerUSD $204
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $123
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number24582
Policy instance 1
Insurance contract or identification number24582
Number of Individuals Covered214
Insurance policy start date2014-09-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $11,991
Total amount of fees paid to insurance companyUSD $58
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $109,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,991
Insurance broker organization code?3
Amount paid for insurance broker fees58
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL30612
Policy instance 2
Insurance contract or identification numberHCL30612
Number of Individuals Covered164
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberVAR 203346
Policy instance 3
Insurance contract or identification numberVAR 203346
Number of Individuals Covered23
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $136
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $1,356
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $136
Insurance broker organization code?3
Insurance broker nameHEALY & ASSOCIATES, INC.

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