401k Plan data: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY plan

CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 401k Plan overview

Plan Name	CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY
Plan identification number	505

CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

BRENT BROWN has sponsored the creation of one or more 401k plans.

Company Name: BRENT BROWN

Employer identification number (EIN): 582294107

NAIC Classification: 561600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2015-01-01 BRENT BROWN BRENT BROWN 2016-06-22
505 2014-02-01 BRENT BROWN BRENT BROWN 2015-07-06
505 2013-02-01 BRENT BROWN BRENT BROWN 2014-07-02
505 2012-02-01 BRENT BROWN BRENT BROWN 2013-05-09
505 2011-02-01 BRENT BROWN
505 2010-02-01 SHERON SIKORSKI
505 2009-02-01 SHERON SIKORSKI

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
505	2015-01-01	BRENT BROWN	BRENT BROWN	2016-06-22
505	2014-02-01	BRENT BROWN	BRENT BROWN	2015-07-06
505	2013-02-01	BRENT BROWN	BRENT BROWN	2014-07-02
505	2012-02-01	BRENT BROWN	BRENT BROWN	2013-05-09
505	2011-02-01	BRENT BROWN
505	2010-02-01	SHERON SIKORSKI
505	2009-02-01	SHERON SIKORSKI

Plan Statistics for CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY

401k plan membership statisitcs for CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY

Measure Date Value
2015: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2015 401k membership
Total participants, beginning-of-year 2015-01-01 167
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 225
Total of all active and inactive participants 2015-01-01 225
Total participants 2015-01-01 225
2014: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year 2014-02-01 154
Total number of active participants reported on line 7a of the Form 5500 2014-02-01 167
Total of all active and inactive participants 2014-02-01 167
Total participants 2014-02-01 167
2013: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year 2013-02-01 152
Total number of active participants reported on line 7a of the Form 5500 2013-02-01 154
Total of all active and inactive participants 2013-02-01 154
Total participants 2013-02-01 154
2012: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year 2012-02-01 101
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 152
Number of retired or separated participants receiving benefits 2012-02-01 0
Number of other retired or separated participants entitled to future benefits 2012-02-01 0
Total of all active and inactive participants 2012-02-01 152
Total participants 2012-02-01 152
2011: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year 2011-02-01 85
Total number of active participants reported on line 7a of the Form 5500 2011-02-01 101
Number of retired or separated participants receiving benefits 2011-02-01 0
Number of other retired or separated participants entitled to future benefits 2011-02-01 0
Total of all active and inactive participants 2011-02-01 101
Total participants 2011-02-01 101
2010: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2010 401k membership
Total participants, beginning-of-year 2010-02-01 77
Total number of active participants reported on line 7a of the Form 5500 2010-02-01 85
Total of all active and inactive participants 2010-02-01 85
Total participants 2010-02-01 85
2009: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year 2009-02-01 111
Total number of active participants reported on line 7a of the Form 5500 2009-02-01 77
Total of all active and inactive participants 2009-02-01 77
Total participants 2009-02-01 77

Measure	Date	Value
2015: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2015 401k membership
Total participants, beginning-of-year	2015-01-01	167
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	225
Total of all active and inactive participants	2015-01-01	225
Total participants	2015-01-01	225
2014: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2014 401k membership
Total participants, beginning-of-year	2014-02-01	154
Total number of active participants reported on line 7a of the Form 5500	2014-02-01	167
Total of all active and inactive participants	2014-02-01	167
Total participants	2014-02-01	167
2013: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2013 401k membership
Total participants, beginning-of-year	2013-02-01	152
Total number of active participants reported on line 7a of the Form 5500	2013-02-01	154
Total of all active and inactive participants	2013-02-01	154
Total participants	2013-02-01	154
2012: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2012 401k membership
Total participants, beginning-of-year	2012-02-01	101
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	152
Number of retired or separated participants receiving benefits	2012-02-01	0
Number of other retired or separated participants entitled to future benefits	2012-02-01	0
Total of all active and inactive participants	2012-02-01	152
Total participants	2012-02-01	152
2011: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2011 401k membership
Total participants, beginning-of-year	2011-02-01	85
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	101
Number of retired or separated participants receiving benefits	2011-02-01	0
Number of other retired or separated participants entitled to future benefits	2011-02-01	0
Total of all active and inactive participants	2011-02-01	101
Total participants	2011-02-01	101
2010: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2010 401k membership
Total participants, beginning-of-year	2010-02-01	77
Total number of active participants reported on line 7a of the Form 5500	2010-02-01	85
Total of all active and inactive participants	2010-02-01	85
Total participants	2010-02-01	85
2009: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2009 401k membership
Total participants, beginning-of-year	2009-02-01	111
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	77
Total of all active and inactive participants	2009-02-01	77
Total participants	2009-02-01	77

Form 5500 Responses for CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY

2015: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2014 form 5500 responses
2014-02-01	Type of plan entity	Single employer plan
2014-02-01	First time form 5500 has been submitted	Yes
2014-02-01	Submission has been amended	No
2014-02-01	This submission is the final filing	No
2014-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-02-01	Plan is a collectively bargained plan	No
2014-02-01	Plan funding arrangement – Insurance	Yes
2014-02-01	Plan benefit arrangement – Insurance	Yes
2013: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2013 form 5500 responses
2013-02-01	Type of plan entity	Single employer plan
2013-02-01	First time form 5500 has been submitted	Yes
2013-02-01	Submission has been amended	No
2013-02-01	This submission is the final filing	No
2013-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-02-01	Plan is a collectively bargained plan	No
2013-02-01	Plan funding arrangement – Insurance	Yes
2013-02-01	Plan benefit arrangement – Insurance	Yes
2012: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2012 form 5500 responses
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	First time form 5500 has been submitted	Yes
2012-02-01	Submission has been amended	No
2012-02-01	This submission is the final filing	No
2012-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-02-01	Plan is a collectively bargained plan	No
2012-02-01	Plan funding arrangement – Insurance	Yes
2012-02-01	Plan benefit arrangement – Insurance	Yes
2011: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	First time form 5500 has been submitted	Yes
2011-02-01	Submission has been amended	No
2011-02-01	This submission is the final filing	No
2011-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-02-01	Plan is a collectively bargained plan	No
2011-02-01	Plan funding arrangement – Insurance	Yes
2011-02-01	Plan benefit arrangement – Insurance	Yes
2010: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2010 form 5500 responses
2010-02-01	Type of plan entity	Single employer plan
2010-02-01	First time form 5500 has been submitted	Yes
2010-02-01	Submission has been amended	No
2010-02-01	This submission is the final filing	No
2010-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-02-01	Plan is a collectively bargained plan	No
2010-02-01	Plan funding arrangement – Insurance	Yes
2010-02-01	Plan benefit arrangement – Insurance	Yes
2009: CHESLEY BROWN INTERNATIONAL SHORT TERM LONG TERM DISABILITY 2009 form 5500 responses
2009-02-01	Type of plan entity	Single employer plan
2009-02-01	First time form 5500 has been submitted	Yes
2009-02-01	Submission has been amended	No
2009-02-01	This submission is the final filing	No
2009-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-02-01	Plan is a collectively bargained plan	No
2009-02-01	Plan funding arrangement – Insurance	Yes
2009-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

07184

Policy instance

Insurance contract or identification number	07184
Number of Individuals Covered	225
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,661
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 $31,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,661
Insurance broker name	J SMITH LANIER & CO

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

07184

Policy instance

Insurance contract or identification number	07184
Number of Individuals Covered	167
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $4,269
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 $28,461
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,269
Insurance broker organization code?	3
Insurance broker name	J. SMITH LANIER & CO.

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

07184

Policy instance

Insurance contract or identification number	07184
Number of Individuals Covered	154
Insurance policy start date	2013-02-01
Insurance policy end date	2014-01-31
Total amount of commissions paid to insurance broker	USD $3,943
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 $24,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,709
Insurance broker organization code?	3
Insurance broker name	J SMITH LANIER & CO

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

07184

Policy instance

Insurance contract or identification number	07184
Number of Individuals Covered	152
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $3,856
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $511
Insurance broker name	J SMITH LANIER & CO

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

07184

Policy instance

Insurance contract or identification number	07184
Number of Individuals Covered	101
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $2,502
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

07184

Policy instance

Insurance contract or identification number	07184
Number of Individuals Covered	85
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $2,450
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2450
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3
Insurance broker name	J SMITH LANIER & CO

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Company Name:	BRENT BROWN
Employer identification number (EIN):	582294107
NAIC Classification:	561600