401k Plan data: BERTOLINI CORPORATION WELFARE BENEFIT PLAN plan

BERTOLINI CORPORATION WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	BERTOLINI CORPORATION WELFARE BENEFIT PLAN
Plan identification number	501

BERTOLINI CORPORATION WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

BERTOLINI CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: BERTOLINI CORPORATION

Employer identification number (EIN): 330554834

NAIC Classification: 337000

Additional information about BERTOLINI CORPORATION

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C1721438

More information about BERTOLINI CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BERTOLINI CORPORATION WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-03-01 CECILIA MINAYA
501 2014-03-01 CECILIA MINAYA

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2015-03-01	CECILIA MINAYA
501	2014-03-01	CECILIA MINAYA

Plan Statistics for BERTOLINI CORPORATION WELFARE BENEFIT PLAN

401k plan membership statisitcs for BERTOLINI CORPORATION WELFARE BENEFIT PLAN

Measure Date Value
2015: BERTOLINI CORPORATION WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-03-01 119
Total number of active participants reported on line 7a of the Form 5500 2015-03-01 103
Total of all active and inactive participants 2015-03-01 103
Total participants 2015-03-01 0
2014: BERTOLINI CORPORATION WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-03-01 99
Total number of active participants reported on line 7a of the Form 5500 2014-03-01 119
Total of all active and inactive participants 2014-03-01 119
Total participants 2014-03-01 0

Measure	Date	Value
2015: BERTOLINI CORPORATION WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-03-01	119
Total number of active participants reported on line 7a of the Form 5500	2015-03-01	103
Total of all active and inactive participants	2015-03-01	103
Total participants	2015-03-01	0
2014: BERTOLINI CORPORATION WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-03-01	99
Total number of active participants reported on line 7a of the Form 5500	2014-03-01	119
Total of all active and inactive participants	2014-03-01	119
Total participants	2014-03-01	0

Form 5500 Responses for BERTOLINI CORPORATION WELFARE BENEFIT PLAN

2015: BERTOLINI CORPORATION WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-03-01	Type of plan entity	Single employer plan
2015-03-01	Plan funding arrangement – Insurance	Yes
2015-03-01	Plan benefit arrangement – Insurance	Yes
2014: BERTOLINI CORPORATION WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-03-01	Type of plan entity	Single employer plan
2014-03-01	First time form 5500 has been submitted	Yes
2014-03-01	Plan funding arrangement – Insurance	Yes
2014-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE SHIELD OF CALIFORNIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61557 )

Policy contract number

W0053887

Policy instance

Insurance contract or identification number	W0053887
Number of Individuals Covered	99
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $438
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $438
Insurance broker organization code?	3
Insurance broker name	JAMES M. GILMOUR, INC

CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )

Policy contract number

W0053887

Policy instance

Insurance contract or identification number	W0053887
Number of Individuals Covered	103
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $24,669
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $493,380
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,669
Insurance broker organization code?	3
Insurance broker name	JAMES M. GILMOUR, INC.

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00510313

Policy instance

Insurance contract or identification number	00510313
Number of Individuals Covered	73
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $4,633
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY LIFE AND AD & D
Welfare Benefit Premiums Paid to Carrier	USD $46,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,310
Insurance broker organization code?	3
Insurance broker name	PACIFIC ADVISORS, INC.

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

76259A/15629A

Policy instance

Insurance contract or identification number	76259A/15629A
Number of Individuals Covered	79
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $506,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

KM05998696

Policy instance

Insurance contract or identification number	KM05998696
Number of Individuals Covered	119
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $2,425
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD & D
Welfare Benefit Premiums Paid to Carrier	USD $26,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,425
Insurance broker organization code?	3
Insurance broker name	JAMES M. GILMOUR, INC

SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 )

Policy contract number

KM05998696

Policy instance

Insurance contract or identification number	KM05998696
Number of Individuals Covered	89
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $996
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $996
Insurance broker organization code?	3
Insurance broker name	JAMES M. GILMOUR, INC.

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Company Name:	BERTOLINI CORPORATION
Employer identification number (EIN):	330554834
NAIC Classification:	337000

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C1721438