401k Plan data: BERKSHIRE INDUSTRIES, INC. LIFE & DISABILITY PLAN plan

BERKSHIRE INDUSTRIES, INC. LIFE & DISABILITY PLAN 401k Plan overview

Plan Name	BERKSHIRE INDUSTRIES, INC. LIFE & DISABILITY PLAN
Plan identification number	502

BERKSHIRE INDUSTRIES, INC. LIFE & DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

BERKSHIRE INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.

Company Name: BERKSHIRE INDUSTRIES, INC.

Employer identification number (EIN): 371786836

NAIC Classification: 332700

Additional information about BERKSHIRE INDUSTRIES, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2015-07-01

Company Identification Number: P15000055726

Legal Registered Office Address: 11380 PROSPERITY FARMS RD #221E

PALM BEACH GARDENS

33410

More information about BERKSHIRE INDUSTRIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BERKSHIRE INDUSTRIES, INC. LIFE & DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-08-01 SONJA HUTCHINS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2015-08-01	SONJA HUTCHINS

Plan Statistics for BERKSHIRE INDUSTRIES, INC. LIFE & DISABILITY PLAN

401k plan membership statisitcs for BERKSHIRE INDUSTRIES, INC. LIFE & DISABILITY PLAN

Measure Date Value
2015: BERKSHIRE INDUSTRIES, INC. LIFE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-08-01 144
Total number of active participants reported on line 7a of the Form 5500 2015-08-01 128
Number of retired or separated participants receiving benefits 2015-08-01 0
Number of other retired or separated participants entitled to future benefits 2015-08-01 0
Total of all active and inactive participants 2015-08-01 128

Measure	Date	Value
2015: BERKSHIRE INDUSTRIES, INC. LIFE & DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-08-01	144
Total number of active participants reported on line 7a of the Form 5500	2015-08-01	128
Number of retired or separated participants receiving benefits	2015-08-01	0
Number of other retired or separated participants entitled to future benefits	2015-08-01	0
Total of all active and inactive participants	2015-08-01	128

Form 5500 Responses for BERKSHIRE INDUSTRIES, INC. LIFE & DISABILITY PLAN

2015: BERKSHIRE INDUSTRIES, INC. LIFE & DISABILITY PLAN 2015 form 5500 responses
2015-08-01	Type of plan entity	Single employer plan
2015-08-01	First time form 5500 has been submitted	Yes
2015-08-01	Submission has been amended	No
2015-08-01	This submission is the final filing	No
2015-08-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-08-01	Plan is a collectively bargained plan	No
2015-08-01	Plan funding arrangement – Insurance	Yes
2015-08-01	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

3339095

Policy instance

Insurance contract or identification number	3339095
Number of Individuals Covered	131
Insurance policy start date	2015-08-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
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	Yes
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 $46,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM606794*

Policy instance

Insurance contract or identification number	SGM606794*
Number of Individuals Covered	128
Insurance policy start date	2015-08-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
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 $24,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BERKSHIRE INDUSTRIES, INC.
Employer identification number (EIN):	371786836
NAIC Classification:	332700

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2015-07-01
Company Identification Number:	P15000055726
Legal Registered Office Address:	11380 PROSPERITY FARMS RD #221E PALM BEACH GARDENS 33410