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BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 401k Plan overview

Plan NameBLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN
Plan identification number 501

BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

BLOCKHOUSE COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name:BLOCKHOUSE COMPANY, INC.
Employer identification number (EIN):232105251
NAIC Classification:337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01PHILLIP B EUBANKS
5012017-01-01PHILLIP B EUBANKS
5012016-01-01PHILLIP B EUBANKS
5012015-01-01PHILLIP B EUBANKS
5012014-01-01PHIL EUBANKS

Plan Statistics for BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN

401k plan membership statisitcs for BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN

Measure Date Value
2022: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0144
Total number of active participants reported on line 7a of the Form 55002022-01-0141
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0141
2021: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0138
Total number of active participants reported on line 7a of the Form 55002021-01-0143
Number of retired or separated participants receiving benefits2021-01-011
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0144
2020: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0141
Total number of active participants reported on line 7a of the Form 55002020-01-0138
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-0138
2019: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0151
Total number of active participants reported on line 7a of the Form 55002019-01-0141
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-0141
2018: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0158
Total number of active participants reported on line 7a of the Form 55002018-01-0149
Number of retired or separated participants receiving benefits2018-01-012
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0151
2017: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0158
Total number of active participants reported on line 7a of the Form 55002017-01-0158
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0158
2016: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0168
Total number of active participants reported on line 7a of the Form 55002016-01-0158
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0158
2015: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0160
Total number of active participants reported on line 7a of the Form 55002015-01-0167
Number of retired or separated participants receiving benefits2015-01-011
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0168
2014: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0161
Total number of active participants reported on line 7a of the Form 55002014-01-0160
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0160

Financial Data on BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN

Measure Date Value
2022 : BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$22,110
Total plan liabilities at beginning of year2022-12-31$22,437
Total income from all sources2022-12-31$575,820
Expenses. Total of all expenses incurred2022-12-31$413,143
Benefits paid (including direct rollovers)2022-12-31$201,246
Total plan assets at end of year2022-12-31$406,080
Total plan assets at beginning of year2022-12-31$243,730
Value of fidelity bond covering the plan2022-12-31$1,000,000
Total contributions received or receivable from participants2022-12-31$167,845
Expenses. Other expenses not covered elsewhere2022-12-31$222,356
Contributions received from other sources (not participants or employers)2022-12-31$5,168
Other income received2022-12-31$995
Net income (gross income less expenses)2022-12-31$162,677
Net plan assets at end of year (total assets less liabilities)2022-12-31$383,970
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$221,293
Total contributions received or receivable from employer(s)2022-12-31$401,812
Value of corrective distributions2022-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$-10,459
2021 : BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$22,437
Total plan liabilities at beginning of year2021-12-31$29,027
Total income from all sources2021-12-31$537,165
Expenses. Total of all expenses incurred2021-12-31$501,421
Benefits paid (including direct rollovers)2021-12-31$234,946
Total plan assets at end of year2021-12-31$243,730
Total plan assets at beginning of year2021-12-31$214,576
Value of fidelity bond covering the plan2021-12-31$500,000
Total contributions received or receivable from participants2021-12-31$154,988
Expenses. Other expenses not covered elsewhere2021-12-31$189,806
Contributions received from other sources (not participants or employers)2021-12-31$10,558
Other income received2021-12-31$592
Net income (gross income less expenses)2021-12-31$35,744
Net plan assets at end of year (total assets less liabilities)2021-12-31$221,293
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$185,549
Total contributions received or receivable from employer(s)2021-12-31$371,027
Value of corrective distributions2021-12-31$70,000
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$6,669
2020 : BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$29,027
Total plan liabilities at beginning of year2020-12-31$43,349
Total income from all sources2020-12-31$600,155
Expenses. Total of all expenses incurred2020-12-31$492,827
Benefits paid (including direct rollovers)2020-12-31$266,614
Total plan assets at end of year2020-12-31$214,576
Total plan assets at beginning of year2020-12-31$121,570
Value of fidelity bond covering the plan2020-12-31$500,000
Total contributions received or receivable from participants2020-12-31$170,007
Expenses. Other expenses not covered elsewhere2020-12-31$203,151
Contributions received from other sources (not participants or employers)2020-12-31$8,420
Other income received2020-12-31$523
Net income (gross income less expenses)2020-12-31$107,328
Net plan assets at end of year (total assets less liabilities)2020-12-31$185,549
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$78,221
Total contributions received or receivable from employer(s)2020-12-31$421,205
Value of corrective distributions2020-12-31$15,043
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$8,019
2019 : BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$43,349
Total plan liabilities at beginning of year2019-12-31$50,061
Total income from all sources2019-12-31$570,906
Expenses. Total of all expenses incurred2019-12-31$498,158
Benefits paid (including direct rollovers)2019-12-31$280,993
Total plan assets at end of year2019-12-31$121,570
Total plan assets at beginning of year2019-12-31$55,534
Value of fidelity bond covering the plan2019-12-31$250,000
Total contributions received or receivable from participants2019-12-31$163,864
Expenses. Other expenses not covered elsewhere2019-12-31$187,646
Contributions received from other sources (not participants or employers)2019-12-31$8,289
Other income received2019-12-31$214
Net income (gross income less expenses)2019-12-31$72,748
Net plan assets at end of year (total assets less liabilities)2019-12-31$78,221
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$5,473
Total contributions received or receivable from employer(s)2019-12-31$398,539
Value of corrective distributions2019-12-31$21,061
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$8,458
2018 : BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$50,061
Total plan liabilities at beginning of year2018-12-31$50,008
Total income from all sources2018-12-31$577,846
Expenses. Total of all expenses incurred2018-12-31$558,107
Benefits paid (including direct rollovers)2018-12-31$349,013
Total plan assets at end of year2018-12-31$55,534
Total plan assets at beginning of year2018-12-31$35,742
Value of fidelity bond covering the plan2018-12-31$250,000
Total contributions received or receivable from participants2018-12-31$172,753
Expenses. Other expenses not covered elsewhere2018-12-31$190,562
Contributions received from other sources (not participants or employers)2018-12-31$13,921
Other income received2018-12-31$144
Net income (gross income less expenses)2018-12-31$19,739
Net plan assets at end of year (total assets less liabilities)2018-12-31$5,473
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$-14,266
Total contributions received or receivable from employer(s)2018-12-31$391,028
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$18,532
2017 : BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$50,008
Total plan liabilities at beginning of year2017-12-31$104,064
Total income from all sources2017-12-31$625,141
Expenses. Total of all expenses incurred2017-12-31$541,552
Benefits paid (including direct rollovers)2017-12-31$316,097
Total plan assets at end of year2017-12-31$35,742
Total plan assets at beginning of year2017-12-31$6,209
Value of fidelity bond covering the plan2017-12-31$250,000
Total contributions received or receivable from participants2017-12-31$203,034
Expenses. Other expenses not covered elsewhere2017-12-31$195,646
Other income received2017-12-31$22
Net income (gross income less expenses)2017-12-31$83,589
Net plan assets at end of year (total assets less liabilities)2017-12-31$-14,266
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$-97,855
Total contributions received or receivable from employer(s)2017-12-31$422,085
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$29,809
2016 : BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$104,064
Total plan liabilities at beginning of year2016-12-31$66,227
Total income from all sources2016-12-31$611,615
Expenses. Total of all expenses incurred2016-12-31$664,321
Benefits paid (including direct rollovers)2016-12-31$447,424
Total plan assets at end of year2016-12-31$6,209
Total plan assets at beginning of year2016-12-31$21,078
Value of fidelity bond covering the plan2016-12-31$250,000
Total contributions received or receivable from participants2016-12-31$227,110
Expenses. Other expenses not covered elsewhere2016-12-31$181,767
Contributions received from other sources (not participants or employers)2016-12-31$0
Other income received2016-12-31$101
Net income (gross income less expenses)2016-12-31$-52,706
Net plan assets at end of year (total assets less liabilities)2016-12-31$-97,855
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$-45,149
Total contributions received or receivable from employer(s)2016-12-31$384,404
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$35,130
2015 : BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$66,227
Total plan liabilities at beginning of year2015-12-31$98,317
Total income from all sources2015-12-31$595,409
Expenses. Total of all expenses incurred2015-12-31$559,447
Benefits paid (including direct rollovers)2015-12-31$353,635
Total plan assets at end of year2015-12-31$21,078
Total plan assets at beginning of year2015-12-31$17,206
Value of fidelity bond covering the plan2015-12-31$250,000
Total contributions received or receivable from participants2015-12-31$203,528
Expenses. Other expenses not covered elsewhere2015-12-31$171,011
Contributions received from other sources (not participants or employers)2015-12-31$949
Other income received2015-12-31$24
Net income (gross income less expenses)2015-12-31$35,962
Net plan assets at end of year (total assets less liabilities)2015-12-31$-45,149
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$-81,111
Total contributions received or receivable from employer(s)2015-12-31$390,908
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$34,801
2014 : BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2014 401k financial data
Total plan liabilities at end of year2014-12-31$98,317
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$532,926
Expenses. Total of all expenses incurred2014-12-31$614,037
Benefits paid (including direct rollovers)2014-12-31$431,283
Total plan assets at end of year2014-12-31$17,206
Total plan assets at beginning of year2014-12-31$0
Value of fidelity bond covering the plan2014-12-31$250,000
Total contributions received or receivable from participants2014-12-31$182,160
Expenses. Other expenses not covered elsewhere2014-12-31$149,563
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$21
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$-81,111
Net plan assets at end of year (total assets less liabilities)2014-12-31$-81,111
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$0
Total contributions received or receivable from employer(s)2014-12-31$350,745
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$33,191

Form 5500 Responses for BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN

2022: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: BLOCKHOUSE COMPANY, INC. GROUP MEDICAL PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01First time form 5500 has been submittedYes
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement - TrustYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500048
Policy instance 1
Insurance contract or identification number30500048
Number of Individuals Covered41
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 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 $195,123
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 number30500048
Policy instance 1
Insurance contract or identification number30500048
Number of Individuals Covered44
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 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 $167,577
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 number30500048
Policy instance 1
Insurance contract or identification number30500048
Number of Individuals Covered38
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 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 $176,487
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 Covered41
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 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 $161,207
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 Covered49
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 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 $160,247
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 Covered58
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 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 $162,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered0
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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 $-200
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 2
Insurance contract or identification numberVERIS
Number of Individuals Covered67
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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 $135,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered0
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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 $114,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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