401k Plan data: BRIER CREEK GROUP LONG-TERM DISABILITY PLAN plan

BRIER CREEK GROUP LONG-TERM DISABILITY PLAN 401k Plan overview

Plan Name	BRIER CREEK GROUP LONG-TERM DISABILITY PLAN
Plan identification number	505

BRIER CREEK GROUP LONG-TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

BRIER CREEK INTEGRATED PAIN AND SPINE has sponsored the creation of one or more 401k plans.

Company Name: BRIER CREEK INTEGRATED PAIN AND SPINE

Employer identification number (EIN): 208839843

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRIER CREEK GROUP LONG-TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2016-04-01
505 2015-04-01 FRANK KOSTELLO

Plan Statistics for BRIER CREEK GROUP LONG-TERM DISABILITY PLAN

401k plan membership statisitcs for BRIER CREEK GROUP LONG-TERM DISABILITY PLAN

Measure Date Value
2016: BRIER CREEK GROUP LONG-TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-04-01 123
Total number of active participants reported on line 7a of the Form 5500 2016-04-01 98
Number of retired or separated participants receiving benefits 2016-04-01 0
Number of other retired or separated participants entitled to future benefits 2016-04-01 0
Total of all active and inactive participants 2016-04-01 98
2015: BRIER CREEK GROUP LONG-TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-04-01 100
Total number of active participants reported on line 7a of the Form 5500 2015-04-01 123
Number of retired or separated participants receiving benefits 2015-04-01 0
Number of other retired or separated participants entitled to future benefits 2015-04-01 0
Total of all active and inactive participants 2015-04-01 123

Measure	Date	Value
2016: BRIER CREEK GROUP LONG-TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-04-01	123
Total number of active participants reported on line 7a of the Form 5500	2016-04-01	98
Number of retired or separated participants receiving benefits	2016-04-01	0
Number of other retired or separated participants entitled to future benefits	2016-04-01	0
Total of all active and inactive participants	2016-04-01	98
2015: BRIER CREEK GROUP LONG-TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-04-01	100
Total number of active participants reported on line 7a of the Form 5500	2015-04-01	123
Number of retired or separated participants receiving benefits	2015-04-01	0
Number of other retired or separated participants entitled to future benefits	2015-04-01	0
Total of all active and inactive participants	2015-04-01	123

Form 5500 Responses for BRIER CREEK GROUP LONG-TERM DISABILITY PLAN

2016: BRIER CREEK GROUP LONG-TERM DISABILITY PLAN 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	Submission has been amended	No
2016-04-01	This submission is the final filing	No
2016-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-04-01	Plan is a collectively bargained plan	No
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes
2015: BRIER CREEK GROUP LONG-TERM DISABILITY PLAN 2015 form 5500 responses
2015-04-01	Type of plan entity	Single employer plan
2015-04-01	First time form 5500 has been submitted	Yes
2015-04-01	Submission has been amended	No
2015-04-01	This submission is the final filing	No
2015-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-04-01	Plan is a collectively bargained plan	No
2015-04-01	Plan funding arrangement – Insurance	Yes
2015-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10189466

Policy instance

Insurance contract or identification number	10189466
Number of Individuals Covered	123
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $3,600
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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 $24,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,600
Insurance broker organization code?	3
Insurance broker name	ADAM C. ANDREWS

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Company Name:	BRIER CREEK INTEGRATED PAIN AND SPINE
Employer identification number (EIN):	208839843
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)