401k Plan data: BRINE'S REFRIGERATION HEATING & COOLING EMPLOYEE BENEFIT PLAN plan

BRINE'S REFRIGERATION HEATING & COOLING EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	BRINE'S REFRIGERATION HEATING & COOLING EMPLOYEE BENEFIT PLAN
Plan identification number	502

BRINE'S REFRIGERATION HEATING & COOLING EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

BRINE'S REFRIGERATION HEATING & COOLING has sponsored the creation of one or more 401k plans.

Company Name: BRINE'S REFRIGERATION HEATING & COOLING

Employer identification number (EIN): 383026193

NAIC Classification: 238220
NAIC Description: Plumbing, Heating, and Air-Conditioning Contractors

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRINE'S REFRIGERATION HEATING & COOLING EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-06-01 MARTIN BRIN 2023-06-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2021-06-01	MARTIN BRIN	2023-06-26

Plan Statistics for BRINE'S REFRIGERATION HEATING & COOLING EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for BRINE'S REFRIGERATION HEATING & COOLING EMPLOYEE BENEFIT PLAN

Measure Date Value
2021: BRINE'S REFRIGERATION HEATING & COOLING EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-06-01 119
Total number of active participants reported on line 7a of the Form 5500 2021-06-01 127
Number of retired or separated participants receiving benefits 2021-06-01 0
Number of other retired or separated participants entitled to future benefits 2021-06-01 0
Total of all active and inactive participants 2021-06-01 127
Number of employers contributing to the scheme 2021-06-01 0

Measure	Date	Value
2021: BRINE'S REFRIGERATION HEATING & COOLING EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-06-01	119
Total number of active participants reported on line 7a of the Form 5500	2021-06-01	127
Number of retired or separated participants receiving benefits	2021-06-01	0
Number of other retired or separated participants entitled to future benefits	2021-06-01	0
Total of all active and inactive participants	2021-06-01	127
Number of employers contributing to the scheme	2021-06-01	0

Form 5500 Responses for BRINE'S REFRIGERATION HEATING & COOLING EMPLOYEE BENEFIT PLAN

2021: BRINE'S REFRIGERATION HEATING & COOLING EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-06-01	Type of plan entity	Single employer plan
2021-06-01	Plan funding arrangement – Insurance	Yes
2021-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

403353

Policy instance

Insurance contract or identification number	403353
Number of Individuals Covered	144
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $29,307
Total amount of fees paid to insurance company	USD $3,661
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 $4,780
Insurance broker organization code?	3
Amount paid for insurance broker fees	3661
Additional information about fees paid to insurance broker	FEES AND OTHER COMMISSIONS

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )

Policy contract number

446307

Policy instance

Insurance contract or identification number	446307
Number of Individuals Covered	237
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $5,744
Total amount of fees paid to insurance company	USD $3,584
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $143,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,744
Amount paid for insurance broker fees	3584
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

403353

Policy instance

Insurance contract or identification number	403353
Number of Individuals Covered	298
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $84,062
Total amount of fees paid to insurance company	USD $7,515
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 $71,581
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES AND OTHER COMMISSIONS

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Company Name:	BRINE'S REFRIGERATION HEATING & COOLING
Employer identification number (EIN):	383026193
NAIC Classification:	238220
NAIC Description:	Plumbing, Heating, and Air-Conditioning Contractors