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SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 401k Plan overview

Plan NameSRC ELASTOMERICS, INC. GROUP MEDICAL PLAN
Plan identification number 502

SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

SRC ELASTOMERICS, INC. has sponsored the creation of one or more 401k plans.

Company Name:SRC ELASTOMERICS, INC.
Employer identification number (EIN):231127920
NAIC Classification:326200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-12-01
5022020-12-01
5022019-12-01
5022018-12-01
5022017-12-01
5022016-12-01SANDRA RATCLIFFE

Plan Statistics for SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN

401k plan membership statisitcs for SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN

Measure Date Value
2021: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-0175
Total number of active participants reported on line 7a of the Form 55002021-12-0172
Number of retired or separated participants receiving benefits2021-12-010
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-0172
2020: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-0171
Total number of active participants reported on line 7a of the Form 55002020-12-0174
Number of retired or separated participants receiving benefits2020-12-011
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-0175
2019: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-0173
Total number of active participants reported on line 7a of the Form 55002019-12-0170
Number of retired or separated participants receiving benefits2019-12-011
Number of other retired or separated participants entitled to future benefits2019-12-010
Total of all active and inactive participants2019-12-0171
2018: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-0176
Total number of active participants reported on line 7a of the Form 55002018-12-0173
Number of retired or separated participants receiving benefits2018-12-010
Number of other retired or separated participants entitled to future benefits2018-12-010
Total of all active and inactive participants2018-12-0173
2017: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-0166
Total number of active participants reported on line 7a of the Form 55002017-12-0174
Number of retired or separated participants receiving benefits2017-12-012
Number of other retired or separated participants entitled to future benefits2017-12-010
Total of all active and inactive participants2017-12-0176
2016: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-0163
Total number of active participants reported on line 7a of the Form 55002016-12-0166
Number of retired or separated participants receiving benefits2016-12-010
Number of other retired or separated participants entitled to future benefits2016-12-010
Total of all active and inactive participants2016-12-0166

Financial Data on SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN

Measure Date Value
2022 : SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2022 401k financial data
Total plan liabilities at end of year2022-11-30$68,572
Total plan liabilities at beginning of year2022-11-30$65,614
Total income from all sources2022-11-30$1,249,085
Expenses. Total of all expenses incurred2022-11-30$1,007,327
Benefits paid (including direct rollovers)2022-11-30$424,059
Total plan assets at end of year2022-11-30$462,722
Total plan assets at beginning of year2022-11-30$218,006
Value of fidelity bond covering the plan2022-11-30$850,000
Total contributions received or receivable from participants2022-11-30$306,110
Expenses. Other expenses not covered elsewhere2022-11-30$491,304
Contributions received from other sources (not participants or employers)2022-11-30$1,608
Other income received2022-11-30$959
Net income (gross income less expenses)2022-11-30$241,758
Net plan assets at end of year (total assets less liabilities)2022-11-30$394,150
Net plan assets at beginning of year (total assets less liabilities)2022-11-30$152,392
Total contributions received or receivable from employer(s)2022-11-30$940,408
Value of corrective distributions2022-11-30$62,528
Expenses. Administrative service providers (salaries,fees and commissions)2022-11-30$29,436
2021 : SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2021 401k financial data
Total plan liabilities at end of year2021-11-30$65,614
Total plan liabilities at beginning of year2021-11-30$95,242
Total income from all sources2021-11-30$1,143,469
Expenses. Total of all expenses incurred2021-11-30$1,089,915
Benefits paid (including direct rollovers)2021-11-30$595,595
Total plan assets at end of year2021-11-30$218,006
Total plan assets at beginning of year2021-11-30$194,080
Value of fidelity bond covering the plan2021-11-30$1,000,000
Total contributions received or receivable from participants2021-11-30$266,516
Expenses. Other expenses not covered elsewhere2021-11-30$428,795
Contributions received from other sources (not participants or employers)2021-11-30$4,784
Other income received2021-11-30$821
Net income (gross income less expenses)2021-11-30$53,554
Net plan assets at end of year (total assets less liabilities)2021-11-30$152,392
Net plan assets at beginning of year (total assets less liabilities)2021-11-30$98,838
Total contributions received or receivable from employer(s)2021-11-30$871,348
Value of corrective distributions2021-11-30$37,517
Expenses. Administrative service providers (salaries,fees and commissions)2021-11-30$28,008
2020 : SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2020 401k financial data
Total plan liabilities at end of year2020-11-30$95,242
Total plan liabilities at beginning of year2020-11-30$95,985
Total income from all sources2020-11-30$1,186,727
Expenses. Total of all expenses incurred2020-11-30$1,028,229
Benefits paid (including direct rollovers)2020-11-30$567,897
Total plan assets at end of year2020-11-30$194,080
Total plan assets at beginning of year2020-11-30$36,325
Value of fidelity bond covering the plan2020-11-30$850,000
Total contributions received or receivable from participants2020-11-30$0
Expenses. Other expenses not covered elsewhere2020-11-30$420,467
Contributions received from other sources (not participants or employers)2020-11-30$0
Other income received2020-11-30$344
Net income (gross income less expenses)2020-11-30$158,498
Net plan assets at end of year (total assets less liabilities)2020-11-30$98,838
Net plan assets at beginning of year (total assets less liabilities)2020-11-30$-59,660
Total contributions received or receivable from employer(s)2020-11-30$1,186,383
Value of corrective distributions2020-11-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-11-30$39,865
2019 : SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2019 401k financial data
Total plan liabilities at end of year2019-11-30$95,985
Total plan liabilities at beginning of year2019-11-30$64,784
Total income from all sources2019-11-30$1,063,314
Expenses. Total of all expenses incurred2019-11-30$1,109,838
Benefits paid (including direct rollovers)2019-11-30$671,619
Total plan assets at end of year2019-11-30$36,325
Total plan assets at beginning of year2019-11-30$51,648
Value of fidelity bond covering the plan2019-11-30$850,000
Total contributions received or receivable from participants2019-11-30$223,737
Expenses. Other expenses not covered elsewhere2019-11-30$382,022
Contributions received from other sources (not participants or employers)2019-11-30$5,244
Other income received2019-11-30$178
Net income (gross income less expenses)2019-11-30$-46,524
Net plan assets at end of year (total assets less liabilities)2019-11-30$-59,660
Net plan assets at beginning of year (total assets less liabilities)2019-11-30$-13,136
Total contributions received or receivable from employer(s)2019-11-30$834,155
Value of corrective distributions2019-11-30$16,745
Expenses. Administrative service providers (salaries,fees and commissions)2019-11-30$39,452
2017 : SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2017 401k financial data
Total plan liabilities at end of year2017-11-30$44,265
Total plan liabilities at beginning of year2017-11-30$0
Total income from all sources2017-11-30$872,581
Expenses. Total of all expenses incurred2017-11-30$781,443
Benefits paid (including direct rollovers)2017-11-30$440,237
Total plan assets at end of year2017-11-30$135,403
Total plan assets at beginning of year2017-11-30$0
Value of fidelity bond covering the plan2017-11-30$575,000
Total contributions received or receivable from participants2017-11-30$172,553
Expenses. Other expenses not covered elsewhere2017-11-30$309,843
Other income received2017-11-30$130
Net income (gross income less expenses)2017-11-30$91,138
Net plan assets at end of year (total assets less liabilities)2017-11-30$91,138
Net plan assets at beginning of year (total assets less liabilities)2017-11-30$0
Total contributions received or receivable from employer(s)2017-11-30$699,898
Expenses. Administrative service providers (salaries,fees and commissions)2017-11-30$31,363

Form 5500 Responses for SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN

2021: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Submission has been amendedNo
2021-12-01This submission is the final filingNo
2021-12-01This return/report is a short plan year return/report (less than 12 months)No
2021-12-01Plan is a collectively bargained planNo
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan funding arrangement – TrustYes
2021-12-01Plan funding arrangement – General assets of the sponsorYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement - TrustYes
2021-12-01Plan benefit arrangement – General assets of the sponsorYes
2020: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Submission has been amendedNo
2020-12-01This submission is the final filingNo
2020-12-01This return/report is a short plan year return/report (less than 12 months)No
2020-12-01Plan is a collectively bargained planNo
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan funding arrangement – TrustYes
2020-12-01Plan funding arrangement – General assets of the sponsorYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement - TrustYes
2020-12-01Plan benefit arrangement – General assets of the sponsorYes
2019: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Submission has been amendedNo
2019-12-01This submission is the final filingNo
2019-12-01This return/report is a short plan year return/report (less than 12 months)No
2019-12-01Plan is a collectively bargained planNo
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan funding arrangement – TrustYes
2019-12-01Plan funding arrangement – General assets of the sponsorYes
2019-12-01Plan benefit arrangement – InsuranceYes
2019-12-01Plan benefit arrangement - TrustYes
2019-12-01Plan benefit arrangement – General assets of the sponsorYes
2018: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Submission has been amendedNo
2018-12-01This submission is the final filingNo
2018-12-01This return/report is a short plan year return/report (less than 12 months)No
2018-12-01Plan is a collectively bargained planNo
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan funding arrangement – TrustYes
2018-12-01Plan funding arrangement – General assets of the sponsorYes
2018-12-01Plan benefit arrangement – InsuranceYes
2018-12-01Plan benefit arrangement - TrustYes
2018-12-01Plan benefit arrangement – General assets of the sponsorYes
2017: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01Submission has been amendedNo
2017-12-01This submission is the final filingNo
2017-12-01This return/report is a short plan year return/report (less than 12 months)No
2017-12-01Plan is a collectively bargained planNo
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan funding arrangement – TrustYes
2017-12-01Plan funding arrangement – General assets of the sponsorYes
2017-12-01Plan benefit arrangement – InsuranceYes
2017-12-01Plan benefit arrangement - TrustYes
2017-12-01Plan benefit arrangement – General assets of the sponsorYes
2016: SRC ELASTOMERICS, INC. GROUP MEDICAL PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01First time form 5500 has been submittedYes
2016-12-01Submission has been amendedNo
2016-12-01This submission is the final filingNo
2016-12-01This return/report is a short plan year return/report (less than 12 months)No
2016-12-01Plan is a collectively bargained planNo
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan funding arrangement – TrustYes
2016-12-01Plan funding arrangement – General assets of the sponsorYes
2016-12-01Plan benefit arrangement – InsuranceYes
2016-12-01Plan benefit arrangement - TrustYes
2016-12-01Plan 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 number30500237
Policy instance 1
Insurance contract or identification number30500237
Number of Individuals Covered72
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
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 $33,705
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 number30500237
Policy instance 1
Insurance contract or identification number30500237
Number of Individuals Covered74
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
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 $374,775
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 number30500237
Policy instance 1
Insurance contract or identification number30500237
Number of Individuals Covered71
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
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 $366,913
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 Covered73
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
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 $325,075
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 Covered74
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
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 $279,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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