401k Plan data: B.E.A.N. LLC WELFARE BENEFIT PLAN plan

B.E.A.N. LLC WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	B.E.A.N. LLC WELFARE BENEFIT PLAN
Plan identification number	503

B.E.A.N. LLC WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

B.E.A.N. LLC has sponsored the creation of one or more 401k plans.

Company Name: B.E.A.N. LLC

Employer identification number (EIN): 271071465

NAIC Classification: 541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan B.E.A.N. LLC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2017-03-01 JENNIFER WILLIAMS JENNIFER WILLIAMS 2018-09-28
503 2016-03-01 JENNIFER WILLIAMS JENNIFER WILLIAMS 2017-10-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2017-03-01	JENNIFER WILLIAMS		JENNIFER WILLIAMS	2018-09-28
503	2016-03-01	JENNIFER WILLIAMS		JENNIFER WILLIAMS	2017-10-24

Plan Statistics for B.E.A.N. LLC WELFARE BENEFIT PLAN

401k plan membership statisitcs for B.E.A.N. LLC WELFARE BENEFIT PLAN

Measure Date Value
2017: B.E.A.N. LLC WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-03-01 116
Total number of active participants reported on line 7a of the Form 5500 2017-03-01 82
Number of retired or separated participants receiving benefits 2017-03-01 0
Number of other retired or separated participants entitled to future benefits 2017-03-01 0
Total of all active and inactive participants 2017-03-01 82
2016: B.E.A.N. LLC WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-03-01 134
Total number of active participants reported on line 7a of the Form 5500 2016-03-01 116
Number of retired or separated participants receiving benefits 2016-03-01 0
Number of other retired or separated participants entitled to future benefits 2016-03-01 0
Total of all active and inactive participants 2016-03-01 116

Measure	Date	Value
2017: B.E.A.N. LLC WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-03-01	116
Total number of active participants reported on line 7a of the Form 5500	2017-03-01	82
Number of retired or separated participants receiving benefits	2017-03-01	0
Number of other retired or separated participants entitled to future benefits	2017-03-01	0
Total of all active and inactive participants	2017-03-01	82
2016: B.E.A.N. LLC WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-03-01	134
Total number of active participants reported on line 7a of the Form 5500	2016-03-01	116
Number of retired or separated participants receiving benefits	2016-03-01	0
Number of other retired or separated participants entitled to future benefits	2016-03-01	0
Total of all active and inactive participants	2016-03-01	116

Form 5500 Responses for B.E.A.N. LLC WELFARE BENEFIT PLAN

2017: B.E.A.N. LLC WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-03-01	Type of plan entity	Single employer plan
2017-03-01	Submission has been amended	No
2017-03-01	This submission is the final filing	No
2017-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-03-01	Plan is a collectively bargained plan	No
2017-03-01	Plan funding arrangement – Insurance	Yes
2017-03-01	Plan benefit arrangement – Insurance	Yes
2016: B.E.A.N. LLC WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-03-01	Type of plan entity	Single employer plan
2016-03-01	First time form 5500 has been submitted	Yes
2016-03-01	Submission has been amended	No
2016-03-01	This submission is the final filing	No
2016-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-03-01	Plan is a collectively bargained plan	No
2016-03-01	Plan funding arrangement – Insurance	Yes
2016-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G 00614655

Policy instance

Insurance contract or identification number	G 00614655
Number of Individuals Covered	82
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $3,115
Total amount of fees paid to insurance company	USD $1,708
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $25,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,511
Amount paid for insurance broker fees	1708
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	APEX BENEFITS GROUP INC.

DELTA DENTAL OF INDIANA (National Association of Insurance Commissioners NAIC id number: 52634 )

Policy contract number

0000857

Policy instance

Insurance contract or identification number	0000857
Number of Individuals Covered	67
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $2,582
Total amount of fees paid to insurance company	USD $0
Dental 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 $2,049
Insurance broker organization code?	3
Insurance broker name	APEX BENEFITS GROUP, INC.

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )

Policy contract number

00198454

Policy instance

Insurance contract or identification number	00198454
Number of Individuals Covered	76
Insurance policy start date	2017-03-01
Insurance policy end date	2018-02-28
Total amount of commissions paid to insurance broker	USD $17,962
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $389,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,880
Insurance broker organization code?	3
Insurance broker name	APEX BENEFITS GROUP INC.

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Company Name:	B.E.A.N. LLC
Employer identification number (EIN):	271071465
NAIC Classification:	541600