0001193125-11-144104.txt : 20110518 0001193125-11-144104.hdr.sgml : 20110518 20110518152934 ACCESSION NUMBER: 0001193125-11-144104 CONFORMED SUBMISSION TYPE: 11-K PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20101231 FILED AS OF DATE: 20110518 DATE AS OF CHANGE: 20110518 FILER: COMPANY DATA: COMPANY CONFORMED NAME: FREMONT MICHIGAN INSURACORP INC CENTRAL INDEX KEY: 0001271245 STANDARD INDUSTRIAL CLASSIFICATION: FIRE, MARINE & CASUALTY INSURANCE [6331] IRS NUMBER: 421609947 STATE OF INCORPORATION: MI FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 11-K SEC ACT: 1934 Act SEC FILE NUMBER: 000-50926 FILM NUMBER: 11854784 BUSINESS ADDRESS: STREET 1: 933 E. MAIN ST CITY: FREMONT STATE: MI ZIP: 49412 BUSINESS PHONE: 231 924 0300 MAIL ADDRESS: STREET 1: 933 E. MAIN ST CITY: FREMONT STATE: MI ZIP: 49412 11-K 1 d11k.htm FORM 11-K Form 11-K

 

 

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

FORM 11-K

 

 

 

x ANNUAL REPORT PURSUANT TO SECTION 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the fiscal year ended: December 31, 2010

OR

 

¨ TRANSITION REPORT PURSUANT TO SECTION 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from              to             

Commission File Number: 000-50926

 

 

FREMONT INSURANCE COMPANY 401(K) PLAN

(Full Title of Plan)

FREMONT MICHIGAN INSURACORP, INC.

933 E. Main St.

Fremont, Michigan 49412

(Name of Issuer of the Securities Held Pursuant to the Plan and the Address of its Principal Executive Office)

 

 

 

Required Information

The Fremont Insurance Company 401(K) Plan (the “Plan”) is subject to the requirements of the Employee Retirement Income Security Act of 1974 (“ERISA”). The following financial statements and schedules of the Plan have been prepared in accordance with the financial reporting requirements of ERISA under 29 CFR 2520.104-41. The financial statements and schedules are unaudited as the Plan has claimed a waiver of the annual examination and report of an independent qualified public accountant under 29 CFR 2520.104-46.

Fremont Insurance Company 401(K) Plan

Form 5500, Schedule I, Part 1, Line 1 - Plan Assets and Liabilities

(Unaudited)

 

     December 31,
2010		      December 31,
2009		  

Total plan assets

    $ 5,619,374       $ 5,081,080   

Total plan liabilities

      —           —     
                 

Net plan assets

    $ 5,619,374       $ 5,081,080   
                 

Fremont Insurance Company 401(K) Plan

Form 5500, Schedule I, Part 1, Line 2 - Income, Expenses

and Transfers for this Plan Year

(Unaudited)

 

     Year ended
December 31,
2010		  

Additions:

   

Employer contributions

    $ 165,663   

Participants’ contributions

      289,152   

Other income

      545,335   
        

Total additions

      1,000,150   

Deduction - Benefits paid

      461,856   
        

Net income

    $ 538,294   
        

Fremont Insurance Company 401(K) Plan

Form 5500, Schedule I, Part 1, Line 3d - Specific Assets

(Unaudited)

 

     December 31,
2010		  

Fremont Michigan InsuraCorp, Inc. Common Stock

    $ 2,432,252   

Signatures

Pursuant to the requirements of the Securities Exchange Act of 1934, the trustees (or other persons who administer the employee benefit plan) have duly caused this annual report to be signed on its behalf by the undersigned hereunto duly authorized.

Date: May 18, 2011

 

FREMONT INSURANCE COMPANY 401(K) PLAN
By:  

/s/ Richard E. Dunning

 

Richard E. Dunning, Trustee

By:  

/s/ Marvin R. Deur

 

Marvin R. Deur, Trustee

By:  

/s/ Chris Streichhirsch

 

Chris Streichhirsch, Trustee