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FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 401k Plan overview

Plan NameFAMILY INSIGHT, P.C. GROUP MEDICAL PLAN
Plan identification number 501

FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

FAMILY INSIGHT, P.C. has sponsored the creation of one or more 401k plans.

Company Name:FAMILY INSIGHT, P.C.
Employer identification number (EIN):202308383
NAIC Classification:621330
NAIC Description:Offices of Mental Health Practitioners (except Physicians)

Additional information about FAMILY INSIGHT, P.C.

Jurisdiction of Incorporation: Virginia Secretary of State
Incorporation Date: 2005-01-03
Company Identification Number: 0629361
Legal Registered Office Address: 3433 BRAMBLETON AVENUE
SUITE 201A
ROANOKE
United States of America (USA)
24018

More information about FAMILY INSIGHT, P.C.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-07-01
5012017-07-01MARK PHILLIPS
5012016-07-01MARK PHILLIPS

Plan Statistics for FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN

401k plan membership statisitcs for FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN

Measure Date Value
2022: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01112
Total number of active participants reported on line 7a of the Form 55002022-01-01105
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01105
2021: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01124
Total number of active participants reported on line 7a of the Form 55002021-01-01112
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01112
2020: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01102
Total number of active participants reported on line 7a of the Form 55002020-01-01124
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01124
2019: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01139
Total number of active participants reported on line 7a of the Form 55002019-01-01101
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01102
2018: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01107
Total number of active participants reported on line 7a of the Form 55002018-07-01136
Number of retired or separated participants receiving benefits2018-07-013
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01139
2017: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-0191
Total number of active participants reported on line 7a of the Form 55002017-07-01104
Number of retired or separated participants receiving benefits2017-07-013
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01107
2016: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01167
Total number of active participants reported on line 7a of the Form 55002016-07-01167
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01167

Financial Data on FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN

Measure Date Value
2021 : FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$46,578
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$47,021
Total income from all sources (including contributions)2021-12-31$1,031,574
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$828,767
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$439,783
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,031,574
Value of total assets at end of year2021-12-31$414,159
Value of total assets at beginning of year2021-12-31$211,795
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$388,984
Total interest from all sources2021-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$460,409
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$46,578
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$47,021
Administrative expenses (other) incurred2021-12-31$245,375
Total non interest bearing cash at end of year2021-12-31$414,159
Total non interest bearing cash at beginning of year2021-12-31$211,795
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$202,807
Value of net assets at end of year (total assets less liabilities)2021-12-31$367,581
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$164,774
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$37,653
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$439,783
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$571,165
Contract administrator fees2021-12-31$105,956
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31YOUNG, OAKES, BROWN & CO., PC
Accountancy firm EIN2021-12-31251589048
2020 : FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$47,021
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$58,948
Total income from all sources (including contributions)2020-12-31$870,555
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$912,986
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$535,690
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$870,555
Value of total assets at end of year2020-12-31$211,795
Value of total assets at beginning of year2020-12-31$266,153
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$377,296
Total interest from all sources2020-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$439,043
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$47,021
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$58,948
Administrative expenses (other) incurred2020-12-31$237,149
Total non interest bearing cash at end of year2020-12-31$211,795
Total non interest bearing cash at beginning of year2020-12-31$266,153
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-42,431
Value of net assets at end of year (total assets less liabilities)2020-12-31$164,774
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$207,205
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$35,568
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$535,690
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$431,512
Contract administrator fees2020-12-31$104,579
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31YOUNG, OAKES, BROWN & CO., PC
Accountancy firm EIN2020-12-31251589048
2019 : FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$58,948
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$103,914
Total income from all sources (including contributions)2019-12-31$1,161,583
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$880,028
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$491,081
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,161,583
Value of total assets at end of year2019-12-31$266,153
Value of total assets at beginning of year2019-12-31$29,564
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$388,947
Total interest from all sources2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$511,173
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$58,948
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$71,298
Administrative expenses (other) incurred2019-12-31$229,776
Total non interest bearing cash at end of year2019-12-31$266,153
Total non interest bearing cash at beginning of year2019-12-31$29,564
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$281,555
Value of net assets at end of year (total assets less liabilities)2019-12-31$207,205
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$-74,350
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$49,147
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$491,081
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$650,410
Contract administrator fees2019-12-31$110,024
Liabilities. Value of benefit claims payable at end of year2019-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$32,616
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31YOUNG, OAKES, BROWN & CO., PC
Accountancy firm EIN2019-12-31251589048
2018 : FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$103,914
Total plan liabilities at beginning of year2018-12-31$59,047
Total income from all sources2018-12-31$544,779
Expenses. Total of all expenses incurred2018-12-31$592,271
Benefits paid (including direct rollovers)2018-12-31$378,878
Total plan assets at end of year2018-12-31$29,564
Total plan assets at beginning of year2018-12-31$32,189
Value of fidelity bond covering the plan2018-12-31$1,000,000
Total contributions received or receivable from participants2018-12-31$301,522
Expenses. Other expenses not covered elsewhere2018-12-31$180,877
Contributions received from other sources (not participants or employers)2018-12-31$612
Net income (gross income less expenses)2018-12-31$-47,492
Net plan assets at end of year (total assets less liabilities)2018-12-31$-74,350
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$-26,858
Total contributions received or receivable from employer(s)2018-12-31$242,645
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$32,516
Total plan liabilities at end of year2018-06-30$59,047
Total plan liabilities at beginning of year2018-06-30$0
Total income from all sources2018-06-30$861,417
Expenses. Total of all expenses incurred2018-06-30$888,275
Benefits paid (including direct rollovers)2018-06-30$600,123
Total plan assets at end of year2018-06-30$32,189
Total plan assets at beginning of year2018-06-30$0
Total contributions received or receivable from participants2018-06-30$511,132
Expenses. Other expenses not covered elsewhere2018-06-30$233,716
Contributions received from other sources (not participants or employers)2018-06-30$4,416
Other income received2018-06-30$25
Net income (gross income less expenses)2018-06-30$-26,858
Net plan assets at end of year (total assets less liabilities)2018-06-30$-26,858
Net plan assets at beginning of year (total assets less liabilities)2018-06-30$0
Total contributions received or receivable from employer(s)2018-06-30$345,844
Expenses. Administrative service providers (salaries,fees and commissions)2018-06-30$54,436

Form 5500 Responses for FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN

2022: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes
2017: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2016: FAMILY INSIGHT, P.C. GROUP MEDICAL PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01First time form 5500 has been submittedYes
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500292
Policy instance 1
Insurance contract or identification number30500292
Number of Individuals Covered105
Insurance policy start date2022-01-01
Insurance policy end date2022-12-30
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 $282,871
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 number30500292
Policy instance 1
Insurance contract or identification number30500292
Number of Individuals Covered112
Insurance policy start date2021-01-01
Insurance policy end date2021-12-30
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 $245,375
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 number30500292
Policy instance 1
Insurance contract or identification number30500292
Number of Individuals Covered124
Insurance policy start date2020-01-01
Insurance policy end date2020-12-30
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 $237,149
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 number30500292
Policy instance 1
Insurance contract or identification number30500292
Number of Individuals Covered101
Insurance policy start date2019-01-01
Insurance policy end date2019-12-30
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 $229,776
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 numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered107
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
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 $188,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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