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LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 401k Plan overview

Plan NameLAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN
Plan identification number 501

LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN Benefits

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

401k Sponsoring company profile

LAWRENCE CHEVROLET, INC. has sponsored the creation of one or more 401k plans.

Company Name:LAWRENCE CHEVROLET, INC.
Employer identification number (EIN):232147212
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAWRENCE CHEVROLET, INC. GROUP HEALTH 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
5012018-07-01RONDA SCULLEN
5012017-07-01RONDA SCULLEN
5012016-07-01RONDA SCULLEN
5012015-07-01RONDA SCULLEN

Plan Statistics for LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN

401k plan membership statisitcs for LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN

Measure Date Value
2022: LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0144
Total number of active participants reported on line 7a of the Form 55002022-01-0148
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 participants2022-01-0148
2021: LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0144
Total number of active participants reported on line 7a of the Form 55002021-01-0144
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0144
2020: LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0149
Total number of active participants reported on line 7a of the Form 55002020-01-0144
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 participants2020-01-0144
2019: LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0148
Total number of active participants reported on line 7a of the Form 55002019-01-0149
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 participants2019-01-0149
2018: LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-0147
Total number of active participants reported on line 7a of the Form 55002018-07-0147
Number of retired or separated participants receiving benefits2018-07-011
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-0148
2017: LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-0146
Total number of active participants reported on line 7a of the Form 55002017-07-0146
Number of retired or separated participants receiving benefits2017-07-011
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-0147
2016: LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-0148
Total number of active participants reported on line 7a of the Form 55002016-07-0146
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-0146
2015: LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-0147
Total number of active participants reported on line 7a of the Form 55002015-07-0148
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-0148

Financial Data on LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN

Measure Date Value
2022 : LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$33,657
Total plan liabilities at beginning of year2022-12-31$72,661
Total income from all sources2022-12-31$656,652
Expenses. Total of all expenses incurred2022-12-31$643,401
Benefits paid (including direct rollovers)2022-12-31$356,298
Total plan assets at end of year2022-12-31$274,567
Total plan assets at beginning of year2022-12-31$300,320
Value of fidelity bond covering the plan2022-12-31$250,000
Total contributions received or receivable from participants2022-12-31$192,670
Expenses. Other expenses not covered elsewhere2022-12-31$225,517
Contributions received from other sources (not participants or employers)2022-12-31$4,765
Other income received2022-12-31$709
Noncash contributions received2022-12-31$0
Net income (gross income less expenses)2022-12-31$13,251
Net plan assets at end of year (total assets less liabilities)2022-12-31$240,910
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$227,659
Total contributions received or receivable from employer(s)2022-12-31$458,508
Value of certain deemed distributions of participant loans2022-12-31$0
Value of corrective distributions2022-12-31$55,972
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$5,614
2021 : LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$72,661
Total plan liabilities at beginning of year2021-12-31$32,263
Total income from all sources2021-12-31$628,777
Expenses. Total of all expenses incurred2021-12-31$577,777
Benefits paid (including direct rollovers)2021-12-31$277,562
Total plan assets at end of year2021-12-31$300,320
Total plan assets at beginning of year2021-12-31$208,922
Value of fidelity bond covering the plan2021-12-31$250,000
Total contributions received or receivable from participants2021-12-31$230,616
Expenses. Other expenses not covered elsewhere2021-12-31$191,605
Other income received2021-12-31$812
Net income (gross income less expenses)2021-12-31$51,000
Net plan assets at end of year (total assets less liabilities)2021-12-31$227,659
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$176,659
Total contributions received or receivable from employer(s)2021-12-31$397,349
Value of corrective distributions2021-12-31$97,951
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$10,659
2020 : LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$32,263
Total plan liabilities at beginning of year2020-12-31$85,458
Total income from all sources2020-12-31$630,360
Expenses. Total of all expenses incurred2020-12-31$440,996
Benefits paid (including direct rollovers)2020-12-31$188,950
Total plan assets at end of year2020-12-31$208,922
Total plan assets at beginning of year2020-12-31$72,753
Value of fidelity bond covering the plan2020-12-31$250,000
Total contributions received or receivable from participants2020-12-31$187,887
Expenses. Other expenses not covered elsewhere2020-12-31$233,146
Contributions received from other sources (not participants or employers)2020-12-31$9,030
Other income received2020-12-31$300
Net income (gross income less expenses)2020-12-31$189,364
Net plan assets at end of year (total assets less liabilities)2020-12-31$176,659
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$-12,705
Total contributions received or receivable from employer(s)2020-12-31$433,143
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$18,900
2019 : LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$85,458
Total plan liabilities at beginning of year2019-12-31$113,175
Total income from all sources2019-12-31$623,785
Expenses. Total of all expenses incurred2019-12-31$554,542
Benefits paid (including direct rollovers)2019-12-31$370,372
Total plan assets at end of year2019-12-31$72,753
Total plan assets at beginning of year2019-12-31$31,227
Value of fidelity bond covering the plan2019-12-31$250,000
Total contributions received or receivable from participants2019-12-31$227,101
Expenses. Other expenses not covered elsewhere2019-12-31$163,468
Contributions received from other sources (not participants or employers)2019-12-31$1,792
Other income received2019-12-31$59
Net income (gross income less expenses)2019-12-31$69,243
Net plan assets at end of year (total assets less liabilities)2019-12-31$-12,705
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$-81,948
Total contributions received or receivable from employer(s)2019-12-31$394,833
Value of corrective distributions2019-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$20,702
2018 : LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$113,175
Total plan liabilities at beginning of year2018-12-31$98,023
Total income from all sources2018-12-31$313,169
Expenses. Total of all expenses incurred2018-12-31$321,706
Benefits paid (including direct rollovers)2018-12-31$214,232
Total plan assets at end of year2018-12-31$31,227
Total plan assets at beginning of year2018-12-31$24,612
Value of fidelity bond covering the plan2018-12-31$250,000
Total contributions received or receivable from participants2018-12-31$143,555
Expenses. Other expenses not covered elsewhere2018-12-31$81,014
Contributions received from other sources (not participants or employers)2018-12-31$4,071
Other income received2018-12-31$61
Net income (gross income less expenses)2018-12-31$-8,537
Net plan assets at end of year (total assets less liabilities)2018-12-31$-81,948
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$-73,411
Total contributions received or receivable from employer(s)2018-12-31$165,482
Value of corrective distributions2018-12-31$16,147
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$10,313
Total plan liabilities at end of year2018-06-30$98,023
Total plan liabilities at beginning of year2018-06-30$30,260
Total income from all sources2018-06-30$513,512
Expenses. Total of all expenses incurred2018-06-30$581,875
Benefits paid (including direct rollovers)2018-06-30$376,363
Total plan assets at end of year2018-06-30$24,612
Total plan assets at beginning of year2018-06-30$25,212
Value of fidelity bond covering the plan2018-06-30$250,000
Total contributions received or receivable from participants2018-06-30$257,656
Expenses. Other expenses not covered elsewhere2018-06-30$151,130
Contributions received from other sources (not participants or employers)2018-06-30$8,910
Other income received2018-06-30$97
Net income (gross income less expenses)2018-06-30$-68,363
Net plan assets at end of year (total assets less liabilities)2018-06-30$-73,411
Net plan assets at beginning of year (total assets less liabilities)2018-06-30$-5,048
Total contributions received or receivable from employer(s)2018-06-30$246,849
Value of corrective distributions2018-06-30$33,667
Expenses. Administrative service providers (salaries,fees and commissions)2018-06-30$20,715
2017 : LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2017 401k financial data
Total plan liabilities at end of year2017-06-30$30,260
Total plan liabilities at beginning of year2017-06-30$23,603
Total income from all sources2017-06-30$447,610
Expenses. Total of all expenses incurred2017-06-30$489,707
Benefits paid (including direct rollovers)2017-06-30$332,328
Total plan assets at end of year2017-06-30$25,212
Total plan assets at beginning of year2017-06-30$60,652
Value of fidelity bond covering the plan2017-06-30$250,000
Total contributions received or receivable from participants2017-06-30$288,609
Expenses. Other expenses not covered elsewhere2017-06-30$130,543
Contributions received from other sources (not participants or employers)2017-06-30$7,430
Other income received2017-06-30$12
Net income (gross income less expenses)2017-06-30$-42,097
Net plan assets at end of year (total assets less liabilities)2017-06-30$-5,048
Net plan assets at beginning of year (total assets less liabilities)2017-06-30$37,049
Total contributions received or receivable from employer(s)2017-06-30$151,559
Expenses. Administrative service providers (salaries,fees and commissions)2017-06-30$26,836
2016 : LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2016 401k financial data
Total plan liabilities at end of year2016-06-30$23,603
Total plan liabilities at beginning of year2016-06-30$0
Total income from all sources2016-06-30$445,848
Expenses. Total of all expenses incurred2016-06-30$408,799
Benefits paid (including direct rollovers)2016-06-30$242,148
Total plan assets at end of year2016-06-30$60,652
Total plan assets at beginning of year2016-06-30$0
Value of fidelity bond covering the plan2016-06-30$250,000
Total contributions received or receivable from participants2016-06-30$181,536
Expenses. Other expenses not covered elsewhere2016-06-30$139,051
Contributions received from other sources (not participants or employers)2016-06-30$0
Other income received2016-06-30$10
Net income (gross income less expenses)2016-06-30$37,049
Net plan assets at end of year (total assets less liabilities)2016-06-30$37,049
Net plan assets at beginning of year (total assets less liabilities)2016-06-30$0
Total contributions received or receivable from employer(s)2016-06-30$264,302
Expenses. Administrative service providers (salaries,fees and commissions)2016-06-30$27,600

Form 5500 Responses for LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN

2022: LAWRENCE CHEVROLET, INC. GROUP HEALTH 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: LAWRENCE CHEVROLET, INC. GROUP HEALTH 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: LAWRENCE CHEVROLET, INC. GROUP HEALTH 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: LAWRENCE CHEVROLET, INC. GROUP HEALTH 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: LAWRENCE CHEVROLET, INC. GROUP HEALTH 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)Yes
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: LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
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
2016: LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2015: LAWRENCE CHEVROLET, INC. GROUP HEALTH PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01First time form 5500 has been submittedYes
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500131
Policy instance 1
Insurance contract or identification number30500131
Number of Individuals Covered48
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 $194,043
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 number30500131
Policy instance 1
Insurance contract or identification number30500131
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 $161,932
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 number30500131
Policy instance 1
Insurance contract or identification number30500131
Number of Individuals Covered44
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 $156,207
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 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 $147,918
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 Covered47
Insurance policy start date2018-07-01
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 $64,252
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 Covered47
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 $121,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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