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M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameM. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN
Plan identification number 501

M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

M. POTTEIGER INC. has sponsored the creation of one or more 401k plans.

Company Name:M. POTTEIGER INC.
Employer identification number (EIN):231709914
NAIC Classification:238100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-04-01
5012021-04-01
5012020-04-01
5012019-04-01
5012018-04-01
5012017-04-01CONNIE WHITACRE
5012016-04-01CONNIE WHITACRE
5012015-04-01CONNIE WHITACRE
5012015-04-01

Plan Statistics for M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-0118
Total number of active participants reported on line 7a of the Form 55002022-04-0117
Number of retired or separated participants receiving benefits2022-04-010
Number of other retired or separated participants entitled to future benefits2022-04-010
Total of all active and inactive participants2022-04-0117
2021: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-0122
Total number of active participants reported on line 7a of the Form 55002021-04-0118
Number of retired or separated participants receiving benefits2021-04-010
Number of other retired or separated participants entitled to future benefits2021-04-010
Total of all active and inactive participants2021-04-0118
2020: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-0118
Total number of active participants reported on line 7a of the Form 55002020-04-0122
Number of retired or separated participants receiving benefits2020-04-010
Number of other retired or separated participants entitled to future benefits2020-04-010
Total of all active and inactive participants2020-04-0122
2019: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-04-0122
Total number of active participants reported on line 7a of the Form 55002019-04-0118
Number of retired or separated participants receiving benefits2019-04-010
Number of other retired or separated participants entitled to future benefits2019-04-010
Total of all active and inactive participants2019-04-0118
2018: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-04-0124
Total number of active participants reported on line 7a of the Form 55002018-04-0122
Number of retired or separated participants receiving benefits2018-04-010
Number of other retired or separated participants entitled to future benefits2018-04-010
Total of all active and inactive participants2018-04-0122
2017: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-0124
Total number of active participants reported on line 7a of the Form 55002017-04-0124
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-0124
2016: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-0122
Total number of active participants reported on line 7a of the Form 55002016-04-0124
Number of retired or separated participants receiving benefits2016-04-010
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-0124
2015: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-0124
Total number of active participants reported on line 7a of the Form 55002015-04-0122
Number of retired or separated participants receiving benefits2015-04-010
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-0122

Financial Data on M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2023 : M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2023 401k financial data
Total plan liabilities at end of year2023-03-31$9,615
Total plan liabilities at beginning of year2023-03-31$25,518
Total income from all sources2023-03-31$300,459
Expenses. Total of all expenses incurred2023-03-31$295,467
Benefits paid (including direct rollovers)2023-03-31$117,727
Total plan assets at end of year2023-03-31$46,498
Total plan assets at beginning of year2023-03-31$57,409
Value of fidelity bond covering the plan2023-03-31$1,000,000
Total contributions received or receivable from participants2023-03-31$31,020
Expenses. Other expenses not covered elsewhere2023-03-31$135,915
Contributions received from other sources (not participants or employers)2023-03-31$0
Other income received2023-03-31$0
Net income (gross income less expenses)2023-03-31$4,992
Net plan assets at end of year (total assets less liabilities)2023-03-31$36,883
Net plan assets at beginning of year (total assets less liabilities)2023-03-31$31,891
Total contributions received or receivable from employer(s)2023-03-31$269,439
Value of corrective distributions2023-03-31$33,873
Expenses. Administrative service providers (salaries,fees and commissions)2023-03-31$7,952
2022 : M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2022 401k financial data
Total plan liabilities at end of year2022-03-31$25,518
Total plan liabilities at beginning of year2022-03-31$6,768
Total income from all sources2022-03-31$278,688
Expenses. Total of all expenses incurred2022-03-31$319,093
Benefits paid (including direct rollovers)2022-03-31$104,506
Total plan assets at end of year2022-03-31$57,409
Total plan assets at beginning of year2022-03-31$79,064
Value of fidelity bond covering the plan2022-03-31$1,000,000
Total contributions received or receivable from participants2022-03-31$31,625
Expenses. Other expenses not covered elsewhere2022-03-31$124,404
Net income (gross income less expenses)2022-03-31$-40,405
Net plan assets at end of year (total assets less liabilities)2022-03-31$31,891
Net plan assets at beginning of year (total assets less liabilities)2022-03-31$72,296
Total contributions received or receivable from employer(s)2022-03-31$247,063
Value of corrective distributions2022-03-31$81,581
Expenses. Administrative service providers (salaries,fees and commissions)2022-03-31$8,602
2021 : M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2021 401k financial data
Total plan liabilities at end of year2021-03-31$6,768
Total plan liabilities at beginning of year2021-03-31$12,655
Total income from all sources2021-03-31$253,626
Expenses. Total of all expenses incurred2021-03-31$235,373
Benefits paid (including direct rollovers)2021-03-31$113,739
Total plan assets at end of year2021-03-31$79,064
Total plan assets at beginning of year2021-03-31$66,698
Value of fidelity bond covering the plan2021-03-31$1,000,000
Total contributions received or receivable from participants2021-03-31$27,650
Expenses. Other expenses not covered elsewhere2021-03-31$108,835
Contributions received from other sources (not participants or employers)2021-03-31$0
Other income received2021-03-31$0
Net income (gross income less expenses)2021-03-31$18,253
Net plan assets at end of year (total assets less liabilities)2021-03-31$72,296
Net plan assets at beginning of year (total assets less liabilities)2021-03-31$54,043
Total contributions received or receivable from employer(s)2021-03-31$225,976
Value of corrective distributions2021-03-31$4,710
Expenses. Administrative service providers (salaries,fees and commissions)2021-03-31$8,089
2020 : M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2020 401k financial data
Total plan liabilities at end of year2020-03-31$12,655
Total plan liabilities at beginning of year2020-03-31$11,985
Total income from all sources2020-03-31$240,760
Expenses. Total of all expenses incurred2020-03-31$258,156
Benefits paid (including direct rollovers)2020-03-31$119,285
Total plan assets at end of year2020-03-31$66,698
Total plan assets at beginning of year2020-03-31$83,424
Value of fidelity bond covering the plan2020-03-31$1,000,000
Total contributions received or receivable from participants2020-03-31$28,985
Expenses. Other expenses not covered elsewhere2020-03-31$96,015
Contributions received from other sources (not participants or employers)2020-03-31$0
Other income received2020-03-31$0
Net income (gross income less expenses)2020-03-31$-17,396
Net plan assets at end of year (total assets less liabilities)2020-03-31$54,043
Net plan assets at beginning of year (total assets less liabilities)2020-03-31$71,439
Total contributions received or receivable from employer(s)2020-03-31$211,775
Value of corrective distributions2020-03-31$34,337
Expenses. Administrative service providers (salaries,fees and commissions)2020-03-31$8,519
2019 : M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2019 401k financial data
Total plan liabilities at end of year2019-03-31$11,985
Total plan liabilities at beginning of year2019-03-31$9,073
Total income from all sources2019-03-31$302,047
Expenses. Total of all expenses incurred2019-03-31$341,730
Benefits paid (including direct rollovers)2019-03-31$158,314
Total plan assets at end of year2019-03-31$83,424
Total plan assets at beginning of year2019-03-31$120,195
Value of fidelity bond covering the plan2019-03-31$1,000,000
Total contributions received or receivable from participants2019-03-31$36,882
Expenses. Other expenses not covered elsewhere2019-03-31$116,126
Net income (gross income less expenses)2019-03-31$-39,683
Net plan assets at end of year (total assets less liabilities)2019-03-31$71,439
Net plan assets at beginning of year (total assets less liabilities)2019-03-31$111,122
Total contributions received or receivable from employer(s)2019-03-31$265,165
Value of corrective distributions2019-03-31$56,289
Expenses. Administrative service providers (salaries,fees and commissions)2019-03-31$11,001
2018 : M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2018 401k financial data
Total plan liabilities at end of year2018-03-31$9,073
Total plan liabilities at beginning of year2018-03-31$10,973
Total income from all sources2018-03-31$275,243
Expenses. Total of all expenses incurred2018-03-31$194,510
Benefits paid (including direct rollovers)2018-03-31$72,933
Total plan assets at end of year2018-03-31$120,195
Total plan assets at beginning of year2018-03-31$41,362
Value of fidelity bond covering the plan2018-03-31$1,000,000
Total contributions received or receivable from participants2018-03-31$35,655
Expenses. Other expenses not covered elsewhere2018-03-31$99,245
Net income (gross income less expenses)2018-03-31$80,733
Net plan assets at end of year (total assets less liabilities)2018-03-31$111,122
Net plan assets at beginning of year (total assets less liabilities)2018-03-31$30,389
Total contributions received or receivable from employer(s)2018-03-31$239,588
Value of corrective distributions2018-03-31$11,812
Expenses. Administrative service providers (salaries,fees and commissions)2018-03-31$10,520
2017 : M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2017 401k financial data
Total plan liabilities at end of year2017-03-31$10,973
Total plan liabilities at beginning of year2017-03-31$9,498
Total income from all sources2017-03-31$257,228
Expenses. Total of all expenses incurred2017-03-31$220,077
Benefits paid (including direct rollovers)2017-03-31$111,125
Total plan assets at end of year2017-03-31$41,362
Total plan assets at beginning of year2017-03-31$2,736
Value of fidelity bond covering the plan2017-03-31$1,000,000
Total contributions received or receivable from participants2017-03-31$36,095
Expenses. Other expenses not covered elsewhere2017-03-31$97,842
Contributions received from other sources (not participants or employers)2017-03-31$0
Net income (gross income less expenses)2017-03-31$37,151
Net plan assets at end of year (total assets less liabilities)2017-03-31$30,389
Net plan assets at beginning of year (total assets less liabilities)2017-03-31$-6,762
Total contributions received or receivable from employer(s)2017-03-31$221,133
Expenses. Administrative service providers (salaries,fees and commissions)2017-03-31$11,110
2016 : M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2016 401k financial data
Total plan liabilities at end of year2016-03-31$9,498
Total plan liabilities at beginning of year2016-03-31$0
Total income from all sources2016-03-31$202,243
Expenses. Total of all expenses incurred2016-03-31$209,005
Benefits paid (including direct rollovers)2016-03-31$122,432
Total plan assets at end of year2016-03-31$2,736
Total plan assets at beginning of year2016-03-31$0
Value of fidelity bond covering the plan2016-03-31$1,000,000
Total contributions received or receivable from participants2016-03-31$34,055
Expenses. Other expenses not covered elsewhere2016-03-31$75,962
Contributions received from other sources (not participants or employers)2016-03-31$0
Other income received2016-03-31$18
Net income (gross income less expenses)2016-03-31$-6,762
Net plan assets at end of year (total assets less liabilities)2016-03-31$-6,762
Net plan assets at beginning of year (total assets less liabilities)2016-03-31$0
Total contributions received or receivable from employer(s)2016-03-31$168,170
Expenses. Administrative service providers (salaries,fees and commissions)2016-03-31$10,611

Form 5500 Responses for M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN

2022: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingNo
2022-04-01This return/report is a short plan year return/report (less than 12 months)No
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – TrustYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement - TrustYes
2021: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan funding arrangement – TrustYes
2021-04-01Plan benefit arrangement – InsuranceYes
2021-04-01Plan benefit arrangement - TrustYes
2020: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Submission has been amendedNo
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)No
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan funding arrangement – TrustYes
2020-04-01Plan benefit arrangement – InsuranceYes
2020-04-01Plan benefit arrangement - TrustYes
2019: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingNo
2019-04-01This return/report is a short plan year return/report (less than 12 months)No
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – InsuranceYes
2019-04-01Plan funding arrangement – TrustYes
2019-04-01Plan benefit arrangement – InsuranceYes
2019-04-01Plan benefit arrangement - TrustYes
2018: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – InsuranceYes
2018-04-01Plan funding arrangement – TrustYes
2018-04-01Plan benefit arrangement – InsuranceYes
2018-04-01Plan benefit arrangement - TrustYes
2017: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan funding arrangement – TrustYes
2017-04-01Plan benefit arrangement – InsuranceYes
2017-04-01Plan benefit arrangement - TrustYes
2016: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – TrustYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement - TrustYes
2015: M. POTTEIGER, INC. EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01First time form 5500 has been submittedYes
2015-04-01Submission has been amendedYes
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – TrustYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500113
Policy instance 1
Insurance contract or identification number30500113
Number of Individuals Covered17
Insurance policy start date2022-04-01
Insurance policy end date2023-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $124,512
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 number30500113
Policy instance 1
Insurance contract or identification number30500113
Number of Individuals Covered18
Insurance policy start date2021-04-01
Insurance policy end date2022-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $111,656
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 number30500113
Policy instance 1
Insurance contract or identification number30500113
Number of Individuals Covered22
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $97,069
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 number30500113
Policy instance 1
Insurance contract or identification number30500113
Number of Individuals Covered18
Insurance policy start date2019-04-01
Insurance policy end date2020-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $83,113
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 Covered22
Insurance policy start date2018-04-01
Insurance policy end date2019-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $101,678
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 Covered24
Insurance policy start date2017-04-01
Insurance policy end date2018-03-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $93,612
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 Covered22
Insurance policy start date2015-04-01
Insurance policy end date2016-03-31
Are there contracts with allocated funds for individual policies?No
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 $62,005
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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