401k Plan data: BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN plan

BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN 401k Plan overview

Plan Name	BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN
Plan identification number	501

BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN Benefits

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

401k Sponsoring company profile

BRUSH MASTERS, INC. has sponsored the creation of one or more 401k plans.

Company Name: BRUSH MASTERS, INC.

Employer identification number (EIN): 411701189

NAIC Classification: 238300

Additional information about BRUSH MASTERS, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2016-03-14

Company Identification Number: P16000024047

Legal Registered Office Address: 5575 S. SEMORAN BLVD

ORLANDO

32822

More information about BRUSH MASTERS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-08-01 DENEENE LEBLANC
501 2014-08-01 DENEENE LEBLANC VAUGHN LENHART 2016-02-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2015-08-01	DENEENE LEBLANC
501	2014-08-01	DENEENE LEBLANC		VAUGHN LENHART	2016-02-09

Plan Statistics for BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN

401k plan membership statisitcs for BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN

Measure Date Value
2015: BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-08-01 116
Total number of active participants reported on line 7a of the Form 5500 2015-08-01 99
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 99
2014: BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-08-01 102
Total number of active participants reported on line 7a of the Form 5500 2014-08-01 116
Number of retired or separated participants receiving benefits 2014-08-01 0
Number of other retired or separated participants entitled to future benefits 2014-08-01 0
Total of all active and inactive participants 2014-08-01 116

Measure	Date	Value
2015: BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-08-01	116
Total number of active participants reported on line 7a of the Form 5500	2015-08-01	99
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	99
2014: BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-08-01	102
Total number of active participants reported on line 7a of the Form 5500	2014-08-01	116
Number of retired or separated participants receiving benefits	2014-08-01	0
Number of other retired or separated participants entitled to future benefits	2014-08-01	0
Total of all active and inactive participants	2014-08-01	116

Form 5500 Responses for BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN

2015: BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN 2015 form 5500 responses
2015-08-01	Type of plan entity	Single employer plan
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)	No
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
2014: BRUSH MASTERS, INC. LIFE AND DISABILITY PLAN 2014 form 5500 responses
2014-08-01	Type of plan entity	Single employer plan
2014-08-01	First time form 5500 has been submitted	Yes
2014-08-01	Submission has been amended	No
2014-08-01	This submission is the final filing	No
2014-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-08-01	Plan is a collectively bargained plan	No
2014-08-01	Plan funding arrangement – Insurance	Yes
2014-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

01927

Policy instance

Insurance contract or identification number	01927
Number of Individuals Covered	99
Insurance policy start date	2015-08-01
Insurance policy end date	2016-07-31
Total amount of commissions paid to insurance broker	USD $2,235
Total amount of fees paid to insurance company	USD $390
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 & 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 $15,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,235
Amount paid for insurance broker fees	353
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	AXA ASSISTANCE, USA

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

01927

Policy instance

Insurance contract or identification number	01927
Number of Individuals Covered	116
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $2,752
Total amount of fees paid to insurance company	USD $357
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 & 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 $20,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,752
Amount paid for insurance broker fees	320
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	AXA ASSISTANCE, USA

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Company Name:	BRUSH MASTERS, INC.
Employer identification number (EIN):	411701189
NAIC Classification:	238300

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2016-03-14
Company Identification Number:	P16000024047
Legal Registered Office Address:	5575 S. SEMORAN BLVD ORLANDO 32822