401k Plan data: BRILEX LLC MEDICAL PLAN plan

BRILEX LLC MEDICAL PLAN 401k Plan overview

Plan Name	BRILEX LLC MEDICAL PLAN
Plan identification number	504

BRILEX LLC MEDICAL PLAN Benefits

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

401k Sponsoring company profile

BRILEX, LLC has sponsored the creation of one or more 401k plans.

Company Name: BRILEX, LLC

Employer identification number (EIN): 421510958

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRILEX LLC MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2015-01-01 KAREN VANDEWOSTINE KAREN VANDEWOSTINE 2016-07-29
504 2014-01-01 KAREN VANDEWOSTINE KAREN VANDEWOSTINE 2015-09-14
504 2013-03-01 KAREN VANDEWOSTINE KAREN VANDEWOSTINE 2014-09-23
504 2012-03-01 KAREN VANDEWOSTINE KAREN VANDEWOSTINE 2013-12-09

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2015-01-01	KAREN VANDEWOSTINE	KAREN VANDEWOSTINE	2016-07-29
504	2014-01-01	KAREN VANDEWOSTINE	KAREN VANDEWOSTINE	2015-09-14
504	2013-03-01	KAREN VANDEWOSTINE	KAREN VANDEWOSTINE	2014-09-23
504	2012-03-01	KAREN VANDEWOSTINE	KAREN VANDEWOSTINE	2013-12-09

Plan Statistics for BRILEX LLC MEDICAL PLAN

401k plan membership statisitcs for BRILEX LLC MEDICAL PLAN

Measure Date Value
2015: BRILEX LLC MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 102
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 2015-01-01 102
2014: BRILEX LLC MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 136
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 137
2013: BRILEX LLC MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year 2013-03-01 128
Total number of active participants reported on line 7a of the Form 5500 2013-03-01 122
Number of retired or separated participants receiving benefits 2013-03-01 1
Total of all active and inactive participants 2013-03-01 123
2012: BRILEX LLC MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-03-01 81
Total number of active participants reported on line 7a of the Form 5500 2012-03-01 128
Total of all active and inactive participants 2012-03-01 128

Measure	Date	Value
2015: BRILEX LLC MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	102
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	102
2014: BRILEX LLC MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	136
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	137
2013: BRILEX LLC MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year	2013-03-01	128
Total number of active participants reported on line 7a of the Form 5500	2013-03-01	122
Number of retired or separated participants receiving benefits	2013-03-01	1
Total of all active and inactive participants	2013-03-01	123
2012: BRILEX LLC MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-03-01	81
Total number of active participants reported on line 7a of the Form 5500	2012-03-01	128
Total of all active and inactive participants	2012-03-01	128

Form 5500 Responses for BRILEX LLC MEDICAL PLAN

2015: BRILEX LLC MEDICAL PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: BRILEX LLC MEDICAL PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: BRILEX LLC MEDICAL PLAN 2013 form 5500 responses
2013-03-01	Type of plan entity	Single employer plan
2013-03-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-03-01	Plan funding arrangement – Insurance	Yes
2013-03-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-03-01	Plan benefit arrangement – Insurance	Yes
2013-03-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: BRILEX LLC MEDICAL PLAN 2012 form 5500 responses
2012-03-01	Type of plan entity	Single employer plan
2012-03-01	First time form 5500 has been submitted	Yes
2012-03-01	Submission has been amended	Yes
2012-03-01	Plan funding arrangement – Insurance	Yes
2012-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number	968
Policy instance	1
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract number	417002411669
Policy instance	1
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract number	1666
Policy instance	1
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number	00019680
Policy instance	1

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Company Name:	BRILEX, LLC
Employer identification number (EIN):	421510958
NAIC Classification:	238900