401k Plan data: BERNAL LLC LIFE AND DISABILITY PLANS plan

BERNAL LLC LIFE AND DISABILITY PLANS 401k Plan overview

Plan Name	BERNAL LLC LIFE AND DISABILITY PLANS
Plan identification number	504

BERNAL LLC LIFE AND DISABILITY PLANS 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

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

Company Name: BERNAL LLC

Employer identification number (EIN): 421541063

NAIC Classification: 333200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BERNAL LLC LIFE AND DISABILITY PLANS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2020-01-01 JONATHAN MOYER 2021-10-13
504 2019-01-01 JONATHAN MOYER 2021-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2020-01-01	JONATHAN MOYER	2021-10-13
504	2019-01-01	JONATHAN MOYER	2021-10-13

Plan Statistics for BERNAL LLC LIFE AND DISABILITY PLANS

401k plan membership statisitcs for BERNAL LLC LIFE AND DISABILITY PLANS

Measure Date Value
2020: BERNAL LLC LIFE AND DISABILITY PLANS 2020 401k membership
Total participants, beginning-of-year 2020-01-01 154
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 0
Number of employers contributing to the scheme 2020-01-01 0
2019: BERNAL LLC LIFE AND DISABILITY PLANS 2019 401k membership
Total participants, beginning-of-year 2019-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 100
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 2019-01-01 100
Number of employers contributing to the scheme 2019-01-01 0

Measure	Date	Value
2020: BERNAL LLC LIFE AND DISABILITY PLANS 2020 401k membership
Total participants, beginning-of-year	2020-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	0
Number of employers contributing to the scheme	2020-01-01	0
2019: BERNAL LLC LIFE AND DISABILITY PLANS 2019 401k membership
Total participants, beginning-of-year	2019-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	100
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	100
Number of employers contributing to the scheme	2019-01-01	0

Form 5500 Responses for BERNAL LLC LIFE AND DISABILITY PLANS

2020: BERNAL LLC LIFE AND DISABILITY PLANS 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	This submission is the final filing	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: BERNAL LLC LIFE AND DISABILITY PLANS 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

GMDC0BB3H

Policy instance

Insurance contract or identification number	GMDC0BB3H
Number of Individuals Covered	44
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $683
Total amount of fees paid to insurance company	USD $269
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $683
Amount paid for insurance broker fees	269
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BB3H

Policy instance

Insurance contract or identification number	GLUG0BB3H
Number of Individuals Covered	94
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $11,911
Total amount of fees paid to insurance company	USD $6,614
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 AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $105,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,911
Amount paid for insurance broker fees	6614
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )

Policy contract number

GMDC0BB3H

Policy instance

Insurance contract or identification number	GMDC0BB3H
Number of Individuals Covered	47
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $628
Total amount of fees paid to insurance company	USD $29
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $4,188
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BB3H

Policy instance

Insurance contract or identification number	GLUG0BB3H
Number of Individuals Covered	103
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $12,469
Total amount of fees paid to insurance company	USD $2,968
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 AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $110,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BERNAL LLC
Employer identification number (EIN):	421541063
NAIC Classification:	333200