J & L BUILDING MATERIALS, INC. has sponsored the creation of one or more 401k plans.
Additional information about J & L BUILDING MATERIALS, INC.
Submission information for form 5500 for 401k plan J AND L BUILDING MATERIALS GROUP HEALTH PLAN
| Measure | Date | Value |
|---|
| 2023 : J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2023 401k financial data |
|---|
| Total plan liabilities at end of year | 2023-12-31 | $183,635 |
| Total plan liabilities at beginning of year | 2023-12-31 | $349,763 |
| Total income from all sources | 2023-12-31 | $2,462,066 |
| Expenses. Total of all expenses incurred | 2023-12-31 | $1,917,563 |
| Benefits paid (including direct rollovers) | 2023-12-31 | $1,054,640 |
| Total plan assets at end of year | 2023-12-31 | $765,316 |
| Total plan assets at beginning of year | 2023-12-31 | $386,941 |
| Value of fidelity bond covering the plan | 2023-12-31 | $850,000 |
| Total contributions received or receivable from participants | 2023-12-31 | $512,973 |
| Expenses. Other expenses not covered elsewhere | 2023-12-31 | $817,282 |
| Contributions received from other sources (not participants or employers) | 2023-12-31 | $3,623 |
| Other income received | 2023-12-31 | $10,805 |
| Net income (gross income less expenses) | 2023-12-31 | $544,503 |
| Net plan assets at end of year (total assets less liabilities) | 2023-12-31 | $581,681 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-12-31 | $37,178 |
| Total contributions received or receivable from employer(s) | 2023-12-31 | $1,934,665 |
| Value of corrective distributions | 2023-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2023-12-31 | $45,641 |
| 2022 : J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-12-31 | $349,763 |
| Total plan liabilities at beginning of year | 2022-12-31 | $375,463 |
| Total income from all sources | 2022-12-31 | $2,042,464 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $2,018,603 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $1,165,228 |
| Total plan assets at end of year | 2022-12-31 | $386,941 |
| Total plan assets at beginning of year | 2022-12-31 | $388,780 |
| Value of fidelity bond covering the plan | 2022-12-31 | $850,000 |
| Total contributions received or receivable from participants | 2022-12-31 | $428,107 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $688,988 |
| Contributions received from other sources (not participants or employers) | 2022-12-31 | $0 |
| Other income received | 2022-12-31 | $794 |
| Net income (gross income less expenses) | 2022-12-31 | $23,861 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $37,178 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $13,317 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $1,613,563 |
| Value of corrective distributions | 2022-12-31 | $120,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $44,387 |
| 2021 : J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $375,463 |
| Total plan liabilities at beginning of year | 2021-12-31 | $109,931 |
| Total income from all sources | 2021-12-31 | $1,555,726 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $1,959,519 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $1,364,212 |
| Total plan assets at end of year | 2021-12-31 | $388,780 |
| Total plan assets at beginning of year | 2021-12-31 | $527,041 |
| Value of fidelity bond covering the plan | 2021-12-31 | $850,000 |
| Total contributions received or receivable from participants | 2021-12-31 | $359,848 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $534,217 |
| Contributions received from other sources (not participants or employers) | 2021-12-31 | $16,927 |
| Other income received | 2021-12-31 | $963 |
| Net income (gross income less expenses) | 2021-12-31 | $-403,793 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $13,317 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $417,110 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $1,177,988 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $61,090 |
| 2020 : J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-12-31 | $109,931 |
| Total plan liabilities at beginning of year | 2020-12-31 | $135,382 |
| Total income from all sources | 2020-12-31 | $1,750,778 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $1,829,379 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $888,086 |
| Total plan assets at end of year | 2020-12-31 | $527,041 |
| Total plan assets at beginning of year | 2020-12-31 | $631,093 |
| Value of fidelity bond covering the plan | 2020-12-31 | $850,000 |
| Total contributions received or receivable from participants | 2020-12-31 | $145,951 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $577,599 |
| Contributions received from other sources (not participants or employers) | 2020-12-31 | $26,050 |
| Other income received | 2020-12-31 | $1,783 |
| Net income (gross income less expenses) | 2020-12-31 | $-78,601 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $417,110 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $495,711 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $1,576,994 |
| Value of corrective distributions | 2020-12-31 | $300,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $63,694 |
| 2019 : J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $135,382 |
| Total plan liabilities at beginning of year | 2019-12-31 | $134,619 |
| Total income from all sources | 2019-12-31 | $1,636,786 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $1,436,762 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $715,044 |
| Total plan assets at end of year | 2019-12-31 | $631,093 |
| Total plan assets at beginning of year | 2019-12-31 | $430,306 |
| Value of fidelity bond covering the plan | 2019-12-31 | $850,000 |
| Total contributions received or receivable from participants | 2019-12-31 | $424,763 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $460,171 |
| Contributions received from other sources (not participants or employers) | 2019-12-31 | $8,597 |
| Other income received | 2019-12-31 | $1,468 |
| Net income (gross income less expenses) | 2019-12-31 | $200,024 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $495,711 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $295,687 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $1,201,958 |
| Value of corrective distributions | 2019-12-31 | $197,412 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $64,135 |
| 2018 : J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $134,619 |
| Total plan liabilities at beginning of year | 2018-12-31 | $145,095 |
| Total income from all sources | 2018-12-31 | $1,586,864 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $1,337,762 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $800,757 |
| Total plan assets at end of year | 2018-12-31 | $430,306 |
| Total plan assets at beginning of year | 2018-12-31 | $191,680 |
| Value of fidelity bond covering the plan | 2018-12-31 | $850,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $425,390 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $476,945 |
| Other income received | 2018-12-31 | $840 |
| Net income (gross income less expenses) | 2018-12-31 | $249,102 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $295,687 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $46,585 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $1,160,634 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $60,060 |
| 2017 : J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $145,095 |
| Total plan liabilities at beginning of year | 2017-12-31 | $114,955 |
| Total income from all sources | 2017-12-31 | $1,313,611 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $1,328,002 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $858,600 |
| Total plan assets at end of year | 2017-12-31 | $191,680 |
| Total plan assets at beginning of year | 2017-12-31 | $175,931 |
| Value of fidelity bond covering the plan | 2017-12-31 | $850,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $362,933 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $360,624 |
| Contributions received from other sources (not participants or employers) | 2017-12-31 | $0 |
| Other income received | 2017-12-31 | $301 |
| Net income (gross income less expenses) | 2017-12-31 | $-14,391 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $46,585 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $60,976 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $950,377 |
| Value of corrective distributions | 2017-12-31 | $51,961 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $56,817 |
| 2016 : J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $114,955 |
| Total plan liabilities at beginning of year | 2016-12-31 | $341,760 |
| Total income from all sources | 2016-12-31 | $1,241,236 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $891,703 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $441,127 |
| Total plan assets at end of year | 2016-12-31 | $175,931 |
| Total plan assets at beginning of year | 2016-12-31 | $53,203 |
| Value of fidelity bond covering the plan | 2016-12-31 | $850,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $372,782 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $318,252 |
| Contributions received from other sources (not participants or employers) | 2016-12-31 | $731 |
| Other income received | 2016-12-31 | $256 |
| Net income (gross income less expenses) | 2016-12-31 | $349,533 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $60,976 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $-288,557 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $867,467 |
| Value of corrective distributions | 2016-12-31 | $74,645 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $57,679 |
| 2015 : J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-12-31 | $341,760 |
| Total plan liabilities at beginning of year | 2015-12-31 | $0 |
| Total income from all sources | 2015-12-31 | $881,267 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $1,169,824 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $834,825 |
| Total plan assets at end of year | 2015-12-31 | $53,203 |
| Total plan assets at beginning of year | 2015-12-31 | $0 |
| Value of fidelity bond covering the plan | 2015-12-31 | $850,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $296,380 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $233,753 |
| Contributions received from other sources (not participants or employers) | 2015-12-31 | $9,315 |
| Other income received | 2015-12-31 | $155 |
| Net income (gross income less expenses) | 2015-12-31 | $-288,557 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $-288,557 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $575,417 |
| Value of corrective distributions | 2015-12-31 | $56,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $45,246 |
| 2023: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – Trust | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement - Trust | Yes |
| 2022: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 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 funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: J AND L BUILDING MATERIALS GROUP HEALTH PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 407685 |
| Policy instance | 1 |
| Insurance contract or identification number | 407685 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | 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 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $736,052 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 407685 |
| Policy instance | 1 |
| Insurance contract or identification number | 407685 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $612,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 407685 |
| Policy instance | 2 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30500107 |
| Policy instance | 1 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30500107 |
| Policy instance | 1 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | VERIS |
| Policy instance | 1 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | VERIS |
| Policy instance | 1 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | VERIS |
| Policy instance | 1 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3336885 |
| Policy instance | 2 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | VERIS |
| Policy instance | 1 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SOK601437 |
| Policy instance | 5 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGD602268 |
| Policy instance | 4 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGM602338 |
| Policy instance | 3 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT600450 |
| Policy instance | 2 |
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3336885 |
| Policy instance | 1 |
| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 ) |
| Policy contract number | 666699-HNO |
| Policy instance | 3 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SOK601437 |
| Policy instance | 2 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 666699 |
| Policy instance | 1 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 666699 |
| Policy instance | 1 |
| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 ) |
| Policy contract number | 666699-HNO |
| Policy instance | 6 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT600450 |
| Policy instance | 2 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGD602268 |
| Policy instance | 4 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SOK 601437 |
| Policy instance | 5 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGM602338 |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 069798 |
| Policy instance | 9 |
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 803113 |
| Policy instance | 7 |
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 803113 |
| Policy instance | 6 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGD602268 |
| Policy instance | 5 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | VDT600450 |
| Policy instance | 4 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SGM602338 |
| Policy instance | 3 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | SOK 601437 |
| Policy instance | 2 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 666699 |
| Policy instance | 1 |
| MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | PD0849/50 |
| Policy instance | 8 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 666699 |
| Policy instance | 1 |
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 803113 |
| Policy instance | 2 |
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 803113 |
| Policy instance | 3 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 069798 |
| Policy instance | 5 |
| MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | PD0849/50 |
| Policy instance | 4 |
