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ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN 401k Plan overview

Plan NameADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN
Plan identification number 508

ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

ADHESIVES RESEARCH, INC. has sponsored the creation of one or more 401k plans.

Company Name:ADHESIVES RESEARCH, INC.
Employer identification number (EIN):231603865
NAIC Classification:339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5082021-07-01
5082020-07-01
5082019-07-01
5082018-07-01
5082017-07-01

Plan Statistics for ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN

401k plan membership statisitcs for ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN

Measure Date Value
2021: ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01314
Total number of active participants reported on line 7a of the Form 55002021-07-01318
Number of retired or separated participants receiving benefits2021-07-016
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01324
2020: ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01290
Total number of active participants reported on line 7a of the Form 55002020-07-01308
Number of retired or separated participants receiving benefits2020-07-016
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01314
2019: ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01288
Total number of active participants reported on line 7a of the Form 55002019-07-01288
Number of retired or separated participants receiving benefits2019-07-012
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01290
2018: ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01285
Total number of active participants reported on line 7a of the Form 55002018-07-01288
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01288
2017: ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01292
Total number of active participants reported on line 7a of the Form 55002017-07-01285
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01285

Financial Data on ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN

Measure Date Value
2022 : ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$273,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$281,000
Total income from all sources (including contributions)2022-06-30$4,721,066
Total loss/gain on sale of assets2022-06-30$0
Total of all expenses incurred2022-06-30$4,313,043
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$4,177,256
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$4,064,313
Value of total assets at end of year2022-06-30$1,914,724
Value of total assets at beginning of year2022-06-30$1,514,701
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$135,787
Total interest from all sources2022-06-30$2,497
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30No
Was this plan covered by a fidelity bond2022-06-30Yes
Value of fidelity bond cover2022-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$1,170,943
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-06-30$3,607
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-06-30$304,725
Other income not declared elsewhere2022-06-30$654,256
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Value of net income/loss2022-06-30$408,023
Value of net assets at end of year (total assets less liabilities)2022-06-30$1,641,724
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$1,233,701
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-06-30$1,911,117
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-06-30$1,209,976
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-06-30$2,497
Expenses. Payments to insurance carriers foe the provision of benefits2022-06-30$971,362
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30Yes
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Assets. Invements in employer securities at end of year2022-06-30$0
Assets. Invements in employer securities at beginning of year2022-06-30$0
Contributions received in cash from employer2022-06-30$2,893,370
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$3,205,894
Contract administrator fees2022-06-30$135,787
Liabilities. Value of benefit claims payable at end of year2022-06-30$273,000
Liabilities. Value of benefit claims payable at beginning of year2022-06-30$281,000
Did the plan have assets held for investment2022-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30No
Opinion of an independent qualified public accountant for this plan2022-06-30Unqualified
Accountancy firm name2022-06-30STAMBAUGH NESS, INC.
Accountancy firm EIN2022-06-30232846715
2021 : ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$281,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$282,000
Total income from all sources (including contributions)2021-06-30$4,775,292
Total loss/gain on sale of assets2021-06-30$0
Total of all expenses incurred2021-06-30$4,944,208
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$4,791,226
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$4,025,124
Value of total assets at end of year2021-06-30$1,514,701
Value of total assets at beginning of year2021-06-30$1,684,617
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$152,982
Total interest from all sources2021-06-30$208
Total dividends received (eg from common stock, registered investment company shares)2021-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-06-30No
Was this plan covered by a fidelity bond2021-06-30Yes
Value of fidelity bond cover2021-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2021-06-30No
Contributions received from participants2021-06-30$1,089,398
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-06-30$304,725
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-06-30$7,092
Other income not declared elsewhere2021-06-30$749,960
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Value of net income/loss2021-06-30$-168,916
Value of net assets at end of year (total assets less liabilities)2021-06-30$1,233,701
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$1,402,617
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
Were any leases to which the plan was party in default or uncollectible2021-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-06-30$1,209,976
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-06-30$1,677,525
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-06-30$208
Expenses. Payments to insurance carriers foe the provision of benefits2021-06-30$954,543
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-06-30Yes
Was there a failure to transmit to the plan any participant contributions2021-06-30No
Has the plan failed to provide any benefit when due under the plan2021-06-30No
Assets. Invements in employer securities at end of year2021-06-30$0
Assets. Invements in employer securities at beginning of year2021-06-30$0
Contributions received in cash from employer2021-06-30$2,935,726
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-06-30$3,836,683
Contract administrator fees2021-06-30$152,982
Liabilities. Value of benefit claims payable at end of year2021-06-30$281,000
Liabilities. Value of benefit claims payable at beginning of year2021-06-30$282,000
Did the plan have assets held for investment2021-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-06-30No
Opinion of an independent qualified public accountant for this plan2021-06-30Disclaimer
Accountancy firm name2021-06-30STAMBAUGH NESS, INC.
Accountancy firm EIN2021-06-30232846715
2020 : ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$282,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$0
Total income from all sources (including contributions)2020-06-30$4,852,782
Total loss/gain on sale of assets2020-06-30$0
Total of all expenses incurred2020-06-30$4,556,214
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-06-30$4,425,078
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-06-30$3,923,825
Value of total assets at end of year2020-06-30$1,684,617
Value of total assets at beginning of year2020-06-30$1,106,049
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-06-30$131,136
Total interest from all sources2020-06-30$17,406
Total dividends received (eg from common stock, registered investment company shares)2020-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-06-30No
Was this plan covered by a fidelity bond2020-06-30Yes
Value of fidelity bond cover2020-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2020-06-30No
Contributions received from participants2020-06-30$1,005,659
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-06-30$7,092
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-06-30$0
Other income not declared elsewhere2020-06-30$911,551
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Value of net income/loss2020-06-30$296,568
Value of net assets at end of year (total assets less liabilities)2020-06-30$1,402,617
Value of net assets at beginning of year (total assets less liabilities)2020-06-30$1,106,049
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-06-30No
Were any leases to which the plan was party in default or uncollectible2020-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-06-30$1,677,525
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-06-30$1,106,049
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-06-30$17,406
Expenses. Payments to insurance carriers foe the provision of benefits2020-06-30$817,776
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-06-30Yes
Was there a failure to transmit to the plan any participant contributions2020-06-30No
Has the plan failed to provide any benefit when due under the plan2020-06-30No
Assets. Invements in employer securities at end of year2020-06-30$0
Assets. Invements in employer securities at beginning of year2020-06-30$0
Contributions received in cash from employer2020-06-30$2,918,166
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-06-30$3,607,302
Contract administrator fees2020-06-30$131,136
Liabilities. Value of benefit claims payable at end of year2020-06-30$282,000
Liabilities. Value of benefit claims payable at beginning of year2020-06-30$0
Did the plan have assets held for investment2020-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-06-30Yes
Opinion of an independent qualified public accountant for this plan2020-06-30Disclaimer
Accountancy firm name2020-06-30STAMBAUGH NESS, INC.
Accountancy firm EIN2020-06-30232846715
2019 : ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total income from all sources (including contributions)2019-06-30$3,141,994
Total loss/gain on sale of assets2019-06-30$0
Total of all expenses incurred2019-06-30$3,547,325
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$3,447,097
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$3,109,743
Value of total assets at end of year2019-06-30$1,106,049
Value of total assets at beginning of year2019-06-30$1,511,380
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$100,228
Total interest from all sources2019-06-30$32,251
Total dividends received (eg from common stock, registered investment company shares)2019-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30No
Was this plan covered by a fidelity bond2019-06-30Yes
Value of fidelity bond cover2019-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Contributions received from participants2019-06-30$1,161,321
Income. Received or receivable in cash from other sources (including rollovers)2019-06-30$176,698
Administrative expenses (other) incurred2019-06-30$100,228
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Value of net income/loss2019-06-30$-405,331
Value of net assets at end of year (total assets less liabilities)2019-06-30$1,106,049
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$1,511,380
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-06-30$1,106,049
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-06-30$1,511,380
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-06-30$32,251
Expenses. Payments to insurance carriers foe the provision of benefits2019-06-30$844,923
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30Yes
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Assets. Invements in employer securities at end of year2019-06-30$0
Assets. Invements in employer securities at beginning of year2019-06-30$0
Contributions received in cash from employer2019-06-30$1,771,724
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-06-30$2,602,174
Did the plan have assets held for investment2019-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-06-30Yes
Opinion of an independent qualified public accountant for this plan2019-06-30Disclaimer
Accountancy firm name2019-06-30BAKER, TILLY, VIRCHOW, KRAUSE, LLP
Accountancy firm EIN2019-06-30390859910
2018 : ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-06-30$0
Total transfer of assets to this plan2018-06-30$2,181,296
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$0
Total income from all sources (including contributions)2018-06-30$2,980,867
Total loss/gain on sale of assets2018-06-30$0
Total of all expenses incurred2018-06-30$3,650,783
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-06-30$3,543,514
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-06-30$2,961,128
Value of total assets at end of year2018-06-30$1,511,380
Value of total assets at beginning of year2018-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-06-30$107,269
Total interest from all sources2018-06-30$19,739
Total dividends received (eg from common stock, registered investment company shares)2018-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-06-30No
Was this plan covered by a fidelity bond2018-06-30Yes
Value of fidelity bond cover2018-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2018-06-30No
Contributions received from participants2018-06-30$1,281,578
Income. Received or receivable in cash from other sources (including rollovers)2018-06-30$115,943
Administrative expenses (other) incurred2018-06-30$107,269
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Value of net income/loss2018-06-30$-669,916
Value of net assets at end of year (total assets less liabilities)2018-06-30$1,511,380
Value of net assets at beginning of year (total assets less liabilities)2018-06-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-06-30No
Were any leases to which the plan was party in default or uncollectible2018-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-06-30$1,511,380
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-06-30$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-06-30$19,739
Expenses. Payments to insurance carriers foe the provision of benefits2018-06-30$838,888
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-06-30Yes
Was there a failure to transmit to the plan any participant contributions2018-06-30No
Has the plan failed to provide any benefit when due under the plan2018-06-30No
Assets. Invements in employer securities at end of year2018-06-30$0
Assets. Invements in employer securities at beginning of year2018-06-30$0
Contributions received in cash from employer2018-06-30$1,563,607
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-06-30$2,704,626
Did the plan have assets held for investment2018-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-06-30Yes
Opinion of an independent qualified public accountant for this plan2018-06-30Disclaimer
Accountancy firm name2018-06-30BAKER, TILLY, VIRCHOW, KRAUSE, LLP
Accountancy firm EIN2018-06-30390859910

Form 5500 Responses for ADHESIVES RESEARCH, INC. GROUP MEDICAL PLAN

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

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30400003
Policy instance 1
Insurance contract or identification number30400003
Number of Individuals Covered318
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
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 $971,362
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 number30400003
Policy instance 1
Insurance contract or identification number30400003
Number of Individuals Covered314
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
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 $954,542
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 numberKBP
Policy instance 1
Insurance contract or identification numberKBP
Number of Individuals Covered288
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
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 $817,775
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 numberKBP
Policy instance 1
Insurance contract or identification numberKBP
Number of Individuals Covered288
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
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 $844,923
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 numberKBP
Policy instance 1
Insurance contract or identification numberKBP
Number of Individuals Covered285
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 $838,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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