401k Plan data: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN plan

BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 401k Plan overview

Plan Name	BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN
Plan identification number	001

BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

BROOKHAVEN MEDICAL, INC. has sponsored the creation of one or more 401k plans.

Company Name: BROOKHAVEN MEDICAL, INC.

Employer identification number (EIN): 900959093

NAIC Classification: 339110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01
001 2018-01-01
001 2017-01-01 MARC MORIN MARC MORIN 2018-10-11
001 2017-01-01
001 2016-01-01 MARC MORIN MARC MORIN 2017-10-11

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2019-01-01
001	2018-01-01
001	2017-01-01	MARC MORIN	MARC MORIN	2018-10-11
001	2017-01-01
001	2016-01-01	MARC MORIN	MARC MORIN	2017-10-11

Plan Statistics for BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN

401k plan membership statisitcs for BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN

Measure Date Value
2019: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 354
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 0
Number of participants with account balances 2019-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 354
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 305
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 21
Total of all active and inactive participants 2018-01-01 326
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 326
Number of participants with account balances 2018-01-01 90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 319
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 343
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 10
Total of all active and inactive participants 2017-01-01 353
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 353
Number of participants with account balances 2017-01-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 204
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 279
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 5
Total of all active and inactive participants 2016-01-01 284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 284
Number of participants with account balances 2016-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0

Measure	Date	Value
2019: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	354
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	0
Number of participants with account balances	2019-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	354
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	305
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	21
Total of all active and inactive participants	2018-01-01	326
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	326
Number of participants with account balances	2018-01-01	90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	319
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	343
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	10
Total of all active and inactive participants	2017-01-01	353
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	353
Number of participants with account balances	2017-01-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	204
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	279
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	5
Total of all active and inactive participants	2016-01-01	284
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	284
Number of participants with account balances	2016-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0

Financial Data on BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN

Measure	Date	Value
2019 : BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-03-07	$0
Total transfer of assets from this plan	2019-03-07	$747,633
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-03-07	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-03-07	$0
Total income from all sources (including contributions)	2019-03-07	$107,023
Total loss/gain on sale of assets	2019-03-07	$0
Total of all expenses incurred	2019-03-07	$109,628
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-03-07	$106,600
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-03-07	$40,317
Value of total assets at end of year	2019-03-07	$0
Value of total assets at beginning of year	2019-03-07	$750,238
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-03-07	$3,028
Total interest from all sources	2019-03-07	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-03-07	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-03-07	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2019-03-07	$0
Administrative expenses professional fees incurred	2019-03-07	$3,028
Was this plan covered by a fidelity bond	2019-03-07	No
If this is an individual account plan, was there a blackout period	2019-03-07	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-03-07	$0
Were there any nonexempt tranactions with any party-in-interest	2019-03-07	No
Contributions received from participants	2019-03-07	$23,069
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-03-07	No
Value of net income/loss	2019-03-07	$-2,605
Value of net assets at end of year (total assets less liabilities)	2019-03-07	$0
Value of net assets at beginning of year (total assets less liabilities)	2019-03-07	$750,238
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-03-07	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-03-07	No
Were any leases to which the plan was party in default or uncollectible	2019-03-07	No
Value of interest in pooled separate accounts at end of year	2019-03-07	$0
Value of interest in pooled separate accounts at beginning of year	2019-03-07	$650,430
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-03-07	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-03-07	$99,808
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-03-07	$66,706
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-03-07	No
Was there a failure to transmit to the plan any participant contributions	2019-03-07	Yes
Has the plan failed to provide any benefit when due under the plan	2019-03-07	No
Contributions received in cash from employer	2019-03-07	$17,248
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-03-07	$106,600
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-03-07	Yes
Did the plan have assets held for investment	2019-03-07	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-03-07	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-03-07	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-03-07	Yes
Opinion of an independent qualified public accountant for this plan	2019-03-07	Disclaimer
Accountancy firm name	2019-03-07	HENRY & PETERS, P.C.
Accountancy firm EIN	2019-03-07	751503978
2018 : BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$330,299
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$213,900
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$208,492
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$361,062
Value of total assets at end of year	2018-12-31	$750,238
Value of total assets at beginning of year	2018-12-31	$633,839
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$5,408
Total interest from all sources	2018-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2018-12-31	$0
Was this plan covered by a fidelity bond	2018-12-31	No
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$215,471
Other income not declared elsewhere	2018-12-31	$656
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$116,399
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$750,238
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$633,839
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$98
Value of interest in pooled separate accounts at end of year	2018-12-31	$650,430
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$565,071
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$99,808
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$68,768
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-31,419
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$145,591
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$208,492
Contract administrator fees	2018-12-31	$5,310
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	HENRY & PETERS, P.C.
Accountancy firm EIN	2018-12-31	751503978
2017 : BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$536,853
Total of all expenses incurred	2017-12-31	$148,930
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$144,638
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$460,701
Value of total assets at end of year	2017-12-31	$633,839
Value of total assets at beginning of year	2017-12-31	$245,916
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$4,292
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$1,150
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$247,574
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$60,632
Other income not declared elsewhere	2017-12-31	$402
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$387,923
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$633,839
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$245,916
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$95
Value of interest in pooled separate accounts at end of year	2017-12-31	$565,071
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$186,130
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$68,768
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$59,786
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$75,750
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$152,495
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$144,638
Contract administrator fees	2017-12-31	$3,047
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	HENRY & PETERS, P.C.
Accountancy firm EIN	2017-12-31	751503978
2016 : BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2016 401k financial data
Total income from all sources (including contributions)	2016-12-31	$246,841
Total of all expenses incurred	2016-12-31	$925
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$559
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$246,430
Value of total assets at end of year	2016-12-31	$245,916
Value of total assets at beginning of year	2016-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$366
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$366
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$150,514
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$20,000
Other income not declared elsewhere	2016-12-31	$106
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$245,916
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$245,916
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$186,130
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$59,786
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$0
Net investment gain/loss from pooled separate accounts	2016-12-31	$305
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$75,916
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$559
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	HENRY & PETERS, P.C.
Accountancy firm EIN	2016-12-31	751503978

Form 5500 Responses for BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN

2019: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	Yes
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 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 funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: BROOKHAVEN MEDICAL 401(K) RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
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 funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

807308-000

Policy instance

Insurance contract or identification number	807308-000
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-03-07
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $67
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?	Yes
Health Insurance Welfare Benefit	No
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 $0
Amount paid for insurance broker fees	67
Additional information about fees paid to insurance broker	0
Insurance broker organization code?	5

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

807308-000

Policy instance

Insurance contract or identification number	807308-000
Number of Individuals Covered	90
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,060
Total amount of fees paid to insurance company	USD $373
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?	Yes
Health Insurance Welfare Benefit	No
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 $2,060
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	0
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

807308-000

Policy instance

Insurance contract or identification number	807308-000
Number of Individuals Covered	88
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,304
Total amount of fees paid to insurance company	USD $237
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,304
Insurance broker organization code?	3
Amount paid for insurance broker fees	237
Additional information about fees paid to insurance broker	CONTRACT ADMINISTRATION
Insurance broker name	PENSION FINANCIAL SERVICES, INC.

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Company Name:	BROOKHAVEN MEDICAL, INC.
Employer identification number (EIN):	900959093
NAIC Classification:	339110