401k Plan data: APEX CAFETERIA PLAN plan

APEX CAFETERIA PLAN 401k Plan overview

Plan Name	APEX CAFETERIA PLAN
Plan identification number	503

APEX CAFETERIA PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

BROOKSTONE COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: BROOKSTONE COMPANY, INC.

Employer identification number (EIN): 042423478

NAIC Classification: 453220
NAIC Description: Gift, Novelty, and Souvenir Stores

Additional information about BROOKSTONE COMPANY, INC.

Jurisdiction of Incorporation: Vermont Secretary of State Corporations Division

Incorporation Date: 1994-09-07

Company Identification Number: 65271

Legal Registered Office Address: 400 CORNERSTONE DR #240

WILLISTON
United States of America (USA)
05495

More information about BROOKSTONE COMPANY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan APEX CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2019-02-01

Plan Statistics for APEX CAFETERIA PLAN

401k plan membership statisitcs for APEX CAFETERIA PLAN

Measure Date Value
2019: APEX CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year 2019-02-01 120
Total number of active participants reported on line 7a of the Form 5500 2019-02-01 0
Number of retired or separated participants receiving benefits 2019-02-01 0
Number of other retired or separated participants entitled to future benefits 2019-02-01 0
Total of all active and inactive participants 2019-02-01 0

Measure	Date	Value
2019: APEX CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year	2019-02-01	120
Total number of active participants reported on line 7a of the Form 5500	2019-02-01	0
Number of retired or separated participants receiving benefits	2019-02-01	0
Number of other retired or separated participants entitled to future benefits	2019-02-01	0
Total of all active and inactive participants	2019-02-01	0

Form 5500 Responses for APEX CAFETERIA PLAN

2019: APEX CAFETERIA PLAN 2019 form 5500 responses
2019-02-01	Type of plan entity	Single employer plan
2019-02-01	First time form 5500 has been submitted	Yes
2019-02-01	Submission has been amended	No
2019-02-01	This submission is the final filing	Yes
2019-02-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-02-01	Plan is a collectively bargained plan	No
2019-02-01	Plan funding arrangement – Insurance	Yes
2019-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3208784

Policy instance

Insurance contract or identification number	3208784
Number of Individuals Covered	0
Insurance policy start date	2019-02-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $18,550
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Welfare Benefit Premiums Paid to Carrier	USD $1,236,543
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	18550
Additional information about fees paid to insurance broker	BENEFIT ADVISOR PAYMENTS
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30026321

Policy instance

Insurance contract or identification number	30026321
Number of Individuals Covered	0
Insurance policy start date	2019-02-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $803
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
Commission paid to Insurance Broker	USD $803
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0149425

Policy instance

Insurance contract or identification number	0149425
Number of Individuals Covered	0
Insurance policy start date	2019-02-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,317
Total amount of fees paid to insurance company	USD $1,444
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
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 $118,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,317
Amount paid for insurance broker fees	1354
Additional information about fees paid to insurance broker	ADMIN FEES
Insurance broker organization code?	3

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Company Name:	BROOKSTONE COMPANY, INC.
Employer identification number (EIN):	042423478
NAIC Classification:	453220
NAIC Description:	Gift, Novelty, and Souvenir Stores

Jurisdiction of Incorporation:	Vermont Secretary of State Corporations Division
Incorporation Date:	1994-09-07
Company Identification Number:	65271
Legal Registered Office Address:	400 CORNERSTONE DR #240 WILLISTON United States of America (USA) 05495