401k Plan data: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS plan

BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 401k Plan overview

Plan Name	BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS
Plan identification number	505

BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Other welfare benefit cover

401k Sponsoring company profile

BROTOLOC HEALTH CARE SYSTEMS INC. has sponsored the creation of one or more 401k plans.

Company Name: BROTOLOC HEALTH CARE SYSTEMS INC.

Employer identification number (EIN): 391572628

NAIC Classification: 621610
NAIC Description: Home Health Care Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2017-01-01 JOEL BREED
505 2016-01-01 JOEL BREED
505 2015-01-01 JOEL BREED
505 2014-01-01 JOEL BREED
505 2013-01-01 JOEL BREED
505 2012-01-01 JOEL BREED

Plan id#	Filing Submission Date	Name of Administrator
505	2017-01-01	JOEL BREED
505	2016-01-01	JOEL BREED
505	2015-01-01	JOEL BREED
505	2014-01-01	JOEL BREED
505	2013-01-01	JOEL BREED
505	2012-01-01	JOEL BREED

Plan Statistics for BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS

401k plan membership statisitcs for BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS

Measure Date Value
2017: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2017 401k membership
Total participants, beginning-of-year 2017-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 7
Total of all active and inactive participants 2017-01-01 7
Total participants 2017-01-01 7
2016: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2016 401k membership
Total participants, beginning-of-year 2016-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 6
Total of all active and inactive participants 2016-01-01 6
Total participants 2016-01-01 6
2015: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2015 401k membership
Total participants, beginning-of-year 2015-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 6
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 6
Total participants 2015-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2014 401k membership
Total participants, beginning-of-year 2014-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 11
Total of all active and inactive participants 2014-01-01 11
Total participants 2014-01-01 11
2013: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2013 401k membership
Total participants, beginning-of-year 2013-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 11
Total of all active and inactive participants 2013-01-01 11
Total participants 2013-01-01 11
2012: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2012 401k membership
Total participants, beginning-of-year 2012-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 13
Total of all active and inactive participants 2012-01-01 13
Total participants 2012-01-01 13

Measure	Date	Value
2017: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2017 401k membership
Total participants, beginning-of-year	2017-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	7
Total of all active and inactive participants	2017-01-01	7
Total participants	2017-01-01	7
2016: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2016 401k membership
Total participants, beginning-of-year	2016-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	6
Total of all active and inactive participants	2016-01-01	6
Total participants	2016-01-01	6
2015: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2015 401k membership
Total participants, beginning-of-year	2015-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	6
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	6
Total participants	2015-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2014 401k membership
Total participants, beginning-of-year	2014-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	11
Total of all active and inactive participants	2014-01-01	11
Total participants	2014-01-01	11
2013: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2013 401k membership
Total participants, beginning-of-year	2013-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	11
Total of all active and inactive participants	2013-01-01	11
Total participants	2013-01-01	11
2012: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2012 401k membership
Total participants, beginning-of-year	2012-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	13
Total of all active and inactive participants	2012-01-01	13
Total participants	2012-01-01	13

Form 5500 Responses for BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS

2017: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: BROTOLOC HEALTH CARE SYSTEMS INC HEALTH POS 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

SECURITY HEALTH PLAN OF WISCONSIN, INC. (National Association of Insurance Commissioners NAIC id number: 96881 )

Policy contract number

Policy instance

Number of Individuals Covered	7
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,122
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,122
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED BENEFITS & RISK CON

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Company Name:	BROTOLOC HEALTH CARE SYSTEMS INC.
Employer identification number (EIN):	391572628
NAIC Classification:	621610
NAIC Description:	Home Health Care Services