401k Plan data: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT plan

COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 401k Plan overview

Plan Name	COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT
Plan identification number	503

COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT Benefits

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

401k Sponsoring company profile

COLUMBIAN MUTUAL LIFE INSURANCE COMPANY has sponsored the creation of one or more 401k plans.

Company Name: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY

Employer identification number (EIN): 150274455

NAIC Classification: 524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2016-01-01 LESLEY A. FREY
503 2015-01-01 LESLEY A. FREY
503 2014-01-01 LESLEY A. FREY
503 2013-01-01 LESLEY A. FREY
503 2012-01-01 LESLEY A. FREY
503 2011-01-01 LESLEY FREY LESLEY FREY 2012-07-25

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2016-01-01	LESLEY A. FREY
503	2015-01-01	LESLEY A. FREY
503	2014-01-01	LESLEY A. FREY
503	2013-01-01	LESLEY A. FREY
503	2012-01-01	LESLEY A. FREY
503	2011-01-01	LESLEY FREY	LESLEY FREY	2012-07-25

Plan Statistics for COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT

401k plan membership statisitcs for COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT

Measure Date Value
2016: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2016 401k membership
Total participants, beginning-of-year 2016-01-01 246
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
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 0
Total participants 2016-01-01 0
2015: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2015 401k membership
Total participants, beginning-of-year 2015-01-01 231
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 229
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 2015-01-01 229
Total participants 2015-01-01 229
2014: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2014 401k membership
Total participants, beginning-of-year 2014-01-01 239
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 241
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 242
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 242
2013: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2013 401k membership
Total participants, beginning-of-year 2013-01-01 177
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 186
Number of retired or separated participants receiving benefits 2013-01-01 6
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 192
Total participants 2013-01-01 192
2012: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2012 401k membership
Total participants, beginning-of-year 2012-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 184
Number of retired or separated participants receiving benefits 2012-01-01 4
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 188
Total participants 2012-01-01 188
2011: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2011 401k membership
Total participants, beginning-of-year 2011-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 128
Number of retired or separated participants receiving benefits 2011-01-01 4
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 132

Measure	Date	Value
2016: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2016 401k membership
Total participants, beginning-of-year	2016-01-01	246
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
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	0
Total participants	2016-01-01	0
2015: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2015 401k membership
Total participants, beginning-of-year	2015-01-01	231
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	229
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	229
Total participants	2015-01-01	229
2014: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2014 401k membership
Total participants, beginning-of-year	2014-01-01	239
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	241
Number of retired or separated participants receiving benefits	2014-01-01	1
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	242
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	242
2013: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2013 401k membership
Total participants, beginning-of-year	2013-01-01	177
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	186
Number of retired or separated participants receiving benefits	2013-01-01	6
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	192
Total participants	2013-01-01	192
2012: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2012 401k membership
Total participants, beginning-of-year	2012-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	184
Number of retired or separated participants receiving benefits	2012-01-01	4
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	188
Total participants	2012-01-01	188
2011: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2011 401k membership
Total participants, beginning-of-year	2011-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	128
Number of retired or separated participants receiving benefits	2011-01-01	4
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	132

Form 5500 Responses for COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT

2016: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	This submission is the final filing	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: COLUMBIAN MUTUAL LIFE INSURANCE COMPANY HEALTH REIMBURSEMENT ACCOUNT 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	COLUMBIAN MUTUAL LIFE INSURANCE COMPANY
Employer identification number (EIN):	150274455
NAIC Classification:	524140