401k Plan data: BRANDYWINE COMPANIES WELFARE BENEFIT PLAN plan

BRANDYWINE COMPANIES WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	BRANDYWINE COMPANIES WELFARE BENEFIT PLAN
Plan identification number	501

BRANDYWINE COMPANIES WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance) 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

BRANDYWINE AUTO PARTS has sponsored the creation of one or more 401k plans.

Company Name: BRANDYWINE AUTO PARTS

Employer identification number (EIN): 520743797

NAIC Classification: 441300
NAIC Description: Automotive Parts, Accessories, and Tire Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRANDYWINE COMPANIES WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-12-01
501 2017-12-01 DAWN NORRIS 2022-01-18
501 2016-12-01
501 2015-12-01 RICHARD MILLER

Plan Statistics for BRANDYWINE COMPANIES WELFARE BENEFIT PLAN

401k plan membership statisitcs for BRANDYWINE COMPANIES WELFARE BENEFIT PLAN

Measure Date Value
2017: BRANDYWINE COMPANIES WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-12-01 137
Total number of active participants reported on line 7a of the Form 5500 2017-12-01 119
Number of retired or separated participants receiving benefits 2017-12-01 0
Number of other retired or separated participants entitled to future benefits 2017-12-01 0
Total of all active and inactive participants 2017-12-01 119
Number of employers contributing to the scheme 2017-12-01 0
2016: BRANDYWINE COMPANIES WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-12-01 143
Total number of active participants reported on line 7a of the Form 5500 2016-12-01 137
Number of retired or separated participants receiving benefits 2016-12-01 0
Number of other retired or separated participants entitled to future benefits 2016-12-01 0
Total of all active and inactive participants 2016-12-01 137
2015: BRANDYWINE COMPANIES WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-12-01 175
Total number of active participants reported on line 7a of the Form 5500 2015-12-01 143
Number of retired or separated participants receiving benefits 2015-12-01 0
Number of other retired or separated participants entitled to future benefits 2015-12-01 0
Total of all active and inactive participants 2015-12-01 143

Measure	Date	Value
2017: BRANDYWINE COMPANIES WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-12-01	137
Total number of active participants reported on line 7a of the Form 5500	2017-12-01	119
Number of retired or separated participants receiving benefits	2017-12-01	0
Number of other retired or separated participants entitled to future benefits	2017-12-01	0
Total of all active and inactive participants	2017-12-01	119
Number of employers contributing to the scheme	2017-12-01	0
2016: BRANDYWINE COMPANIES WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-12-01	143
Total number of active participants reported on line 7a of the Form 5500	2016-12-01	137
Number of retired or separated participants receiving benefits	2016-12-01	0
Number of other retired or separated participants entitled to future benefits	2016-12-01	0
Total of all active and inactive participants	2016-12-01	137
2015: BRANDYWINE COMPANIES WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-12-01	175
Total number of active participants reported on line 7a of the Form 5500	2015-12-01	143
Number of retired or separated participants receiving benefits	2015-12-01	0
Number of other retired or separated participants entitled to future benefits	2015-12-01	0
Total of all active and inactive participants	2015-12-01	143

Form 5500 Responses for BRANDYWINE COMPANIES WELFARE BENEFIT PLAN

2017: BRANDYWINE COMPANIES WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-12-01	Type of plan entity	Single employer plan
2017-12-01	Submission has been amended	Yes
2017-12-01	Plan funding arrangement – Insurance	Yes
2017-12-01	Plan benefit arrangement – Insurance	Yes
2016: BRANDYWINE COMPANIES WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-12-01	Type of plan entity	Single employer plan
2016-12-01	Plan funding arrangement – Insurance	Yes
2016-12-01	Plan benefit arrangement – Insurance	Yes
2015: BRANDYWINE COMPANIES WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-12-01	Type of plan entity	Single employer plan
2015-12-01	Submission has been amended	No
2015-12-01	This submission is the final filing	No
2015-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-12-01	Plan is a collectively bargained plan	No
2015-12-01	Plan funding arrangement – Insurance	Yes
2015-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )

Policy contract number

0LTT

Policy instance

Insurance contract or identification number	0LTT
Number of Individuals Covered	90
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $21,532
Total amount of fees paid to insurance company	USD $9,199
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $615,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,532
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	WHOLESALER FEE

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

Policy contract number

GLUG0B48Q

Policy instance

Insurance contract or identification number	GLUG0B48Q
Number of Individuals Covered	119
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $7,682
Total amount of fees paid to insurance company	USD $1,910
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	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $63,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,682
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATION

CAREFIRST BLUECHOICE (National Association of Insurance Commissioners NAIC id number: 96202 )

Policy contract number

0LTT

Policy instance

Insurance contract or identification number	0LTT
Number of Individuals Covered	53
Insurance policy start date	2015-12-01
Insurance policy end date	2016-11-30
Total amount of commissions paid to insurance broker	USD $25,647
Total amount of fees paid to insurance company	USD $2,530
Are there contracts with allocated funds for individual policies?	No
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $732,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,647
Amount paid for insurance broker fees	2530
Additional information about fees paid to insurance broker	NON MONETARY INCENTIVE
Insurance broker organization code?	3
Insurance broker name	UNIVEST INSURANCE, INC.

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

5448116

Policy instance

Insurance contract or identification number	5448116
Number of Individuals Covered	143
Insurance policy start date	2015-12-01
Insurance policy end date	2016-11-30
Total amount of commissions paid to insurance broker	USD $7,748
Total amount of fees paid to insurance company	USD $643
Are there contracts with allocated funds for individual policies?	No
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $83,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,748
Amount paid for insurance broker fees	643
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	UNIVEST INSURANCE, INC.

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Company Name:	BRANDYWINE AUTO PARTS
Employer identification number (EIN):	520743797
NAIC Classification:	441300
NAIC Description:	Automotive Parts, Accessories, and Tire Stores

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2017-12-01
501	2017-12-01	DAWN NORRIS	2022-01-18
501	2016-12-01
501	2015-12-01	RICHARD MILLER