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M SIMON ZOOK CO GROUP MEDICAL PLAN 401k Plan overview

Plan NameM SIMON ZOOK CO GROUP MEDICAL PLAN
Plan identification number 503

M SIMON ZOOK CO GROUP MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

M SIMON ZOOK CO has sponsored the creation of one or more 401k plans.

Company Name:M SIMON ZOOK CO
Employer identification number (EIN):231496543
NAIC Classification:311900
NAIC Description: Other Food Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan M SIMON ZOOK CO GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-04-01
5032021-04-01
5032020-04-01
5032020-03-01
5032019-03-01

Plan Statistics for M SIMON ZOOK CO GROUP MEDICAL PLAN

401k plan membership statisitcs for M SIMON ZOOK CO GROUP MEDICAL PLAN

Measure Date Value
2022: M SIMON ZOOK CO GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-01186
Total number of active participants reported on line 7a of the Form 55002022-04-01185
Number of retired or separated participants receiving benefits2022-04-010
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-01185
2021: M SIMON ZOOK CO GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-01194
Total number of active participants reported on line 7a of the Form 55002021-04-01186
Number of retired or separated participants receiving benefits2021-04-010
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-01186
2020: M SIMON ZOOK CO GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-01168
Total number of active participants reported on line 7a of the Form 55002020-04-01194
Number of retired or separated participants receiving benefits2020-04-010
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-01194
Total participants, beginning-of-year2020-03-01187
Total number of active participants reported on line 7a of the Form 55002020-03-01165
Number of retired or separated participants receiving benefits2020-03-013
Number of other retired or separated participants entitled to future benefits2020-03-010
Total of all active and inactive participants2020-03-01168
2019: M SIMON ZOOK CO GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-03-01189
Total number of active participants reported on line 7a of the Form 55002019-03-01184
Number of retired or separated participants receiving benefits2019-03-013
Number of other retired or separated participants entitled to future benefits2019-03-010
Total of all active and inactive participants2019-03-01187

Financial Data on M SIMON ZOOK CO GROUP MEDICAL PLAN

Measure Date Value
2023 : M SIMON ZOOK CO GROUP MEDICAL PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets2023-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-03-31$253,100
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-03-31$211,000
Total income from all sources (including contributions)2023-03-31$3,949,724
Total loss/gain on sale of assets2023-03-31$0
Total of all expenses incurred2023-03-31$3,494,134
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-03-31$3,348,848
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-03-31$3,120,904
Value of total assets at end of year2023-03-31$1,169,961
Value of total assets at beginning of year2023-03-31$672,271
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-03-31$145,286
Total interest from all sources2023-03-31$25,996
Total dividends received (eg from common stock, registered investment company shares)2023-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-03-31No
Was this plan covered by a fidelity bond2023-03-31Yes
Value of fidelity bond cover2023-03-31$500,000
Were there any nonexempt tranactions with any party-in-interest2023-03-31No
Contributions received from participants2023-03-31$242,417
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-03-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-03-31$26,820
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-03-31$100
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-03-31$0
Other income not declared elsewhere2023-03-31$802,824
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-03-31No
Value of net income/loss2023-03-31$455,590
Value of net assets at end of year (total assets less liabilities)2023-03-31$916,861
Value of net assets at beginning of year (total assets less liabilities)2023-03-31$461,271
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-03-31No
Were any leases to which the plan was party in default or uncollectible2023-03-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2023-03-31$1,169,961
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2023-03-31$645,451
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2023-03-31$645,451
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2023-03-31$25,996
Expenses. Payments to insurance carriers foe the provision of benefits2023-03-31$727,406
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-03-31Yes
Was there a failure to transmit to the plan any participant contributions2023-03-31No
Has the plan failed to provide any benefit when due under the plan2023-03-31No
Contributions received in cash from employer2023-03-31$2,878,487
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-03-31$2,621,442
Contract administrator fees2023-03-31$145,286
Liabilities. Value of benefit claims payable at end of year2023-03-31$253,000
Liabilities. Value of benefit claims payable at beginning of year2023-03-31$211,000
Did the plan have assets held for investment2023-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-03-31No
Opinion of an independent qualified public accountant for this plan2023-03-31Unqualified
Accountancy firm name2023-03-31STAMBAUGH NESS, INC.
Accountancy firm EIN2023-03-31232846715
2022 : M SIMON ZOOK CO GROUP MEDICAL PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-03-31$211,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-03-31$164,000
Total income from all sources (including contributions)2022-03-31$3,757,512
Total loss/gain on sale of assets2022-03-31$0
Total of all expenses incurred2022-03-31$4,034,887
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-03-31$3,888,750
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-03-31$2,896,351
Value of total assets at end of year2022-03-31$672,271
Value of total assets at beginning of year2022-03-31$902,646
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-03-31$146,137
Total interest from all sources2022-03-31$97
Total dividends received (eg from common stock, registered investment company shares)2022-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-03-31No
Was this plan covered by a fidelity bond2022-03-31Yes
Value of fidelity bond cover2022-03-31$500,000
Were there any nonexempt tranactions with any party-in-interest2022-03-31No
Contributions received from participants2022-03-31$191,407
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-03-31$26,820
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-03-31$75,830
Other income not declared elsewhere2022-03-31$861,064
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-03-31No
Value of net income/loss2022-03-31$-277,375
Value of net assets at end of year (total assets less liabilities)2022-03-31$461,271
Value of net assets at beginning of year (total assets less liabilities)2022-03-31$738,646
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-03-31No
Were any leases to which the plan was party in default or uncollectible2022-03-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-03-31$645,451
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-03-31$826,816
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-03-31$826,816
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-03-31$97
Expenses. Payments to insurance carriers foe the provision of benefits2022-03-31$667,609
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-03-31Yes
Was there a failure to transmit to the plan any participant contributions2022-03-31No
Has the plan failed to provide any benefit when due under the plan2022-03-31No
Contributions received in cash from employer2022-03-31$2,704,944
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-03-31$3,221,141
Contract administrator fees2022-03-31$146,137
Liabilities. Value of benefit claims payable at end of year2022-03-31$211,000
Liabilities. Value of benefit claims payable at beginning of year2022-03-31$164,000
Did the plan have assets held for investment2022-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-03-31No
Opinion of an independent qualified public accountant for this plan2022-03-31Unqualified
Accountancy firm name2022-03-31STAMBAUGH NESS, INC.
Accountancy firm EIN2022-03-31232846715
2021 : M SIMON ZOOK CO GROUP MEDICAL PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-03-31$164,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-03-31$177,000
Total income from all sources (including contributions)2021-03-31$3,131,010
Total loss/gain on sale of assets2021-03-31$0
Total of all expenses incurred2021-03-31$2,440,048
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-03-31$2,296,025
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-03-31$2,897,367
Value of total assets at end of year2021-03-31$902,646
Value of total assets at beginning of year2021-03-31$224,684
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-03-31$144,023
Total interest from all sources2021-03-31$108
Total dividends received (eg from common stock, registered investment company shares)2021-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-03-31No
Was this plan covered by a fidelity bond2021-03-31Yes
Value of fidelity bond cover2021-03-31$500,000
Were there any nonexempt tranactions with any party-in-interest2021-03-31No
Contributions received from participants2021-03-31$178,154
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-03-31$75,830
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-03-31$124,715
Other income not declared elsewhere2021-03-31$233,535
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-03-31No
Value of net income/loss2021-03-31$690,962
Value of net assets at end of year (total assets less liabilities)2021-03-31$738,646
Value of net assets at beginning of year (total assets less liabilities)2021-03-31$47,684
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-03-31No
Were any leases to which the plan was party in default or uncollectible2021-03-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-03-31$826,816
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-03-31$99,969
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-03-31$99,969
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-03-31$108
Expenses. Payments to insurance carriers foe the provision of benefits2021-03-31$592,413
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-03-31Yes
Was there a failure to transmit to the plan any participant contributions2021-03-31No
Has the plan failed to provide any benefit when due under the plan2021-03-31No
Contributions received in cash from employer2021-03-31$2,719,213
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-03-31$1,703,612
Contract administrator fees2021-03-31$144,023
Liabilities. Value of benefit claims payable at end of year2021-03-31$164,000
Liabilities. Value of benefit claims payable at beginning of year2021-03-31$177,000
Did the plan have assets held for investment2021-03-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-03-31No
Opinion of an independent qualified public accountant for this plan2021-03-31Unqualified
Accountancy firm name2021-03-31STAMBAUGH NESS, INC.
Accountancy firm EIN2021-03-31232846715
2020 : M SIMON ZOOK CO GROUP MEDICAL PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$177,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-03-31$162,000
Total income from all sources (including contributions)2020-03-31$271,754
Total loss/gain on sale of assets2020-03-31$0
Total of all expenses incurred2020-03-31$293,646
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-03-31$281,233
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-03-31$199,780
Value of total assets at end of year2020-03-31$224,684
Value of total assets at beginning of year2020-03-31$231,576
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-03-31$12,413
Total interest from all sources2020-03-31$152
Total dividends received (eg from common stock, registered investment company shares)2020-03-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-03-31No
Was this plan covered by a fidelity bond2020-03-31Yes
Value of fidelity bond cover2020-03-31$500,000
Were there any nonexempt tranactions with any party-in-interest2020-03-31No
Contributions received from participants2020-03-31$12,307
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-03-31$124,715
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-03-31$207,151
Other income not declared elsewhere2020-03-31$71,822
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Value of net income/loss2020-03-31$-21,892
Value of net assets at end of year (total assets less liabilities)2020-03-31$47,684
Value of net assets at beginning of year (total assets less liabilities)2020-03-31$69,576
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-03-31No
Were any leases to which the plan was party in default or uncollectible2020-03-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-03-31$99,969
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-03-31$24,425
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-03-31$24,425
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-03-31$152
Expenses. Payments to insurance carriers foe the provision of benefits2020-03-31$41,312
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-03-31No
Was there a failure to transmit to the plan any participant contributions2020-03-31No
Has the plan failed to provide any benefit when due under the plan2020-03-31No
Contributions received in cash from employer2020-03-31$187,473
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-03-31$239,921
Contract administrator fees2020-03-31$12,413
Liabilities. Value of benefit claims payable at end of year2020-03-31$177,000
Liabilities. Value of benefit claims payable at beginning of year2020-03-31$162,000
Did the plan have assets held for investment2020-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-03-31No
Opinion of an independent qualified public accountant for this plan2020-03-31Disclaimer
Accountancy firm name2020-03-31STAMBAUGH NESS, INC.
Accountancy firm EIN2020-03-31232846715
Total unrealized appreciation/depreciation of assets2020-02-29$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-02-29$162,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-02-29$0
Total income from all sources (including contributions)2020-02-29$2,953,657
Total loss/gain on sale of assets2020-02-29$0
Total of all expenses incurred2020-02-29$2,884,081
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-02-29$2,719,409
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-02-29$2,624,755
Value of total assets at end of year2020-02-29$231,576
Value of total assets at beginning of year2020-02-29$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-02-29$164,672
Total interest from all sources2020-02-29$4,227
Total dividends received (eg from common stock, registered investment company shares)2020-02-29$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-02-29No
Was this plan covered by a fidelity bond2020-02-29Yes
Value of fidelity bond cover2020-02-29$500,000
Were there any nonexempt tranactions with any party-in-interest2020-02-29No
Contributions received from participants2020-02-29$161,565
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-02-29$207,151
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-02-29$0
Other income not declared elsewhere2020-02-29$324,675
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-02-29No
Value of net income/loss2020-02-29$69,576
Value of net assets at end of year (total assets less liabilities)2020-02-29$69,576
Value of net assets at beginning of year (total assets less liabilities)2020-02-29$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-02-29No
Were any loans by the plan or fixed income obligations due to the plan in default2020-02-29No
Were any leases to which the plan was party in default or uncollectible2020-02-29No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-02-29$24,425
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-02-29$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-02-29$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-02-29$4,227
Expenses. Payments to insurance carriers foe the provision of benefits2020-02-29$543,173
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-02-29No
Was there a failure to transmit to the plan any participant contributions2020-02-29No
Has the plan failed to provide any benefit when due under the plan2020-02-29No
Contributions received in cash from employer2020-02-29$2,463,190
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-02-29$2,176,236
Contract administrator fees2020-02-29$164,672
Liabilities. Value of benefit claims payable at end of year2020-02-29$162,000
Liabilities. Value of benefit claims payable at beginning of year2020-02-29$0
Did the plan have assets held for investment2020-02-29No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-02-29No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-02-29No

Form 5500 Responses for M SIMON ZOOK CO GROUP MEDICAL PLAN

2022: M SIMON ZOOK CO GROUP MEDICAL PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingNo
2022-04-01This return/report is a short plan year return/report (less than 12 months)No
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – TrustYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement - TrustYes
2021: M SIMON ZOOK CO GROUP MEDICAL PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – TrustYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement - TrustYes
2020: M SIMON ZOOK CO GROUP MEDICAL PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Submission has been amendedNo
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)No
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – TrustYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement - TrustYes
2020-03-01Type of plan entitySingle employer plan
2020-03-01Submission has been amendedNo
2020-03-01This submission is the final filingNo
2020-03-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-03-01Plan is a collectively bargained planNo
2020-03-01Plan funding arrangement – InsuranceYes
2020-03-01Plan funding arrangement – TrustYes
2020-03-01Plan benefit arrangement – InsuranceYes
2020-03-01Plan benefit arrangement - TrustYes
2019: M SIMON ZOOK CO GROUP MEDICAL PLAN 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01First time form 5500 has been submittedYes
2019-03-01Submission has been amendedNo
2019-03-01This submission is the final filingNo
2019-03-01This return/report is a short plan year return/report (less than 12 months)No
2019-03-01Plan is a collectively bargained planNo
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan funding arrangement – TrustYes
2019-03-01Plan benefit arrangement – InsuranceYes
2019-03-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30400063
Policy instance 1
Insurance contract or identification number30400063
Number of Individuals Covered185
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $727,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30400063
Policy instance 1
Insurance contract or identification number30400063
Number of Individuals Covered186
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $667,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30400063
Policy instance 1
Insurance contract or identification number30400063
Number of Individuals Covered194
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $592,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30400063
Policy instance 1
Insurance contract or identification number30400063
Number of Individuals Covered168
Insurance policy start date2020-03-01
Insurance policy end date2020-03-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $41,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30400063
Policy instance 1
Insurance contract or identification number30400063
Number of Individuals Covered187
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $543,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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