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JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 401k Plan overview

Plan NameJACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN
Plan identification number 501

JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN Benefits

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

401k Sponsoring company profile

JACK GIAMBALVO MOTOR CO INC has sponsored the creation of one or more 401k plans.

Company Name:JACK GIAMBALVO MOTOR CO INC
Employer identification number (EIN):232207372
NAIC Classification:441110
NAIC Description:New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE 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
5012018-01-01DONALD DUSICH
5012017-01-01DONALD DUSICH
5012016-01-01DONALD DUSICH
5012015-01-01DONALD DUSICH
5012014-01-01DONALD DUSICH
5012009-07-01DONALD DUSICH

Plan Statistics for JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN

401k plan membership statisitcs for JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN

Measure Date Value
2022: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01177
Total number of active participants reported on line 7a of the Form 55002022-01-01171
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 participants2022-01-01171
2021: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01161
Total number of active participants reported on line 7a of the Form 55002021-01-01177
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 participants2021-01-01177
2020: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01154
Total number of active participants reported on line 7a of the Form 55002020-01-01161
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 participants2020-01-01161
2019: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01150
Total number of active participants reported on line 7a of the Form 55002019-01-01153
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01154
2018: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01139
Total number of active participants reported on line 7a of the Form 55002018-01-01150
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01150
2017: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01114
Total number of active participants reported on line 7a of the Form 55002017-01-01139
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 participants2017-01-01139
2016: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01129
Total number of active participants reported on line 7a of the Form 55002016-01-01114
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 participants2016-01-01114
2015: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01129
Total number of active participants reported on line 7a of the Form 55002015-01-01125
Number of retired or separated participants receiving benefits2015-01-014
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01129
2014: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01117
Total number of active participants reported on line 7a of the Form 55002014-01-01129
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 participants2014-01-01129
2009: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01142
Total number of active participants reported on line 7a of the Form 55002009-07-01116
Total of all active and inactive participants2009-07-01116
Total participants2009-07-01116

Financial Data on JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN

Measure Date Value
2022 : JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$132,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$128,000
Total income from all sources (including contributions)2022-12-31$2,421,045
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$2,315,386
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$2,173,545
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$2,124,783
Value of total assets at end of year2022-12-31$733,625
Value of total assets at beginning of year2022-12-31$623,966
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$141,841
Total interest from all sources2022-12-31$13,180
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Administrative expenses professional fees incurred2022-12-31$141,841
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$479,687
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$41,548
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$13,128
Other income not declared elsewhere2022-12-31$283,082
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$105,659
Value of net assets at end of year (total assets less liabilities)2022-12-31$601,625
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$495,966
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$692,077
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$610,838
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$610,838
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$13,180
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$572,611
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31Yes
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$1,645,096
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,600,934
Liabilities. Value of benefit claims payable at end of year2022-12-31$132,000
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$128,000
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31STAMBAUGH NESS, INC.
Accountancy firm EIN2022-12-31232846715
2021 : JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$128,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$104,000
Total income from all sources (including contributions)2021-12-31$2,318,809
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$2,284,821
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$2,149,976
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$2,158,924
Value of total assets at end of year2021-12-31$623,966
Value of total assets at beginning of year2021-12-31$565,978
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$134,845
Total interest from all sources2021-12-31$79
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$474,471
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$13,128
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$18,057
Other income not declared elsewhere2021-12-31$159,806
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$33,988
Value of net assets at end of year (total assets less liabilities)2021-12-31$495,966
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$461,978
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$610,838
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$547,921
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$547,921
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$79
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$524,508
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31Yes
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$1,684,453
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,625,468
Contract administrator fees2021-12-31$134,845
Liabilities. Value of benefit claims payable at end of year2021-12-31$128,000
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$104,000
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31STAMBAUGH NESS, INC.
Accountancy firm EIN2021-12-31232846715
2020 : JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$104,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$106,000
Total income from all sources (including contributions)2020-12-31$2,339,301
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$1,958,905
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$1,835,024
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,994,594
Value of total assets at end of year2020-12-31$565,978
Value of total assets at beginning of year2020-12-31$187,582
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$123,881
Total interest from all sources2020-12-31$596
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$339,089
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$18,057
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$27,065
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$0
Other income not declared elsewhere2020-12-31$344,111
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$380,396
Value of net assets at end of year (total assets less liabilities)2020-12-31$461,978
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$81,582
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$547,921
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$160,517
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$160,517
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$596
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$486,620
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31Yes
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$1,655,505
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$1,348,404
Contract administrator fees2020-12-31$123,881
Liabilities. Value of benefit claims payable at end of year2020-12-31$104,000
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$106,000
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31STAMBAUGH NESS, INC.
Accountancy firm EIN2020-12-31232846715
2019 : JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$106,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$77,000
Total income from all sources (including contributions)2019-12-31$2,032,233
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$2,280,618
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$2,159,961
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,495,832
Value of total assets at end of year2019-12-31$187,582
Value of total assets at beginning of year2019-12-31$406,967
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$120,657
Total interest from all sources2019-12-31$7,485
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$365,359
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$27,065
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$15,208
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other income not declared elsewhere2019-12-31$528,916
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-248,385
Value of net assets at end of year (total assets less liabilities)2019-12-31$81,582
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$329,967
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$160,517
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$391,759
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$391,759
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$7,485
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$444,314
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31Yes
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$1,130,473
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$1,715,647
Contract administrator fees2019-12-31$120,657
Liabilities. Value of benefit claims payable at end of year2019-12-31$106,000
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$77,000
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31STAMBAUGH NESS, INC.
Accountancy firm EIN2019-12-31232846715
2018 : JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$77,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$44,472
Total income from all sources (including contributions)2018-12-31$1,416,367
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$1,596,727
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,468,099
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,304,888
Value of total assets at end of year2018-12-31$406,967
Value of total assets at beginning of year2018-12-31$554,799
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$128,628
Total interest from all sources2018-12-31$9,083
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$128,628
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$100,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$362,700
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$15,208
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$44,472
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$44,472
Other income not declared elsewhere2018-12-31$102,396
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-180,360
Value of net assets at end of year (total assets less liabilities)2018-12-31$329,967
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$510,327
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$391,759
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$510,327
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$510,327
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$9,083
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$442,302
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31Yes
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$942,188
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$1,025,797
Liabilities. Value of benefit claims payable at end of year2018-12-31$77,000
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$0
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31STAMBAUGH NESS, INC.
Accountancy firm EIN2018-12-31232846715
2017 : JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$44,472
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$12,194
Total income from all sources (including contributions)2017-12-31$1,225,799
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$1,355,918
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$850,454
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$1,222,401
Value of total assets at end of year2017-12-31$554,799
Value of total assets at beginning of year2017-12-31$652,640
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$505,464
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$3,398
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$3,398
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$100,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$343,848
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$44,472
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$44,472
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$12,194
Administrative expenses (other) incurred2017-12-31$383,978
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$-130,119
Value of net assets at end of year (total assets less liabilities)2017-12-31$510,327
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$640,446
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$750
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$510,327
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$652,640
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31Yes
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$878,553
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$850,454
Contract administrator fees2017-12-31$120,736
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31TROUT, EBERSOLE & GROFF, LLP
Accountancy firm EIN2017-12-31231551315
2016 : JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$12,194
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$42,941
Total income from all sources (including contributions)2016-12-31$1,216,164
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$1,089,516
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$668,083
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,215,454
Value of total assets at end of year2016-12-31$652,640
Value of total assets at beginning of year2016-12-31$556,739
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$421,433
Total interest from all sources2016-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$710
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$710
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$100,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$314,203
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$9,262
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$42,941
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$12,194
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$42,941
Administrative expenses (other) incurred2016-12-31$296,534
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$126,648
Value of net assets at end of year (total assets less liabilities)2016-12-31$640,446
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$513,798
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$750
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$652,640
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$513,798
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$513,798
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31Yes
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$891,989
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$668,083
Contract administrator fees2016-12-31$124,149
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31TROUT, EBERSOLE & GROFF, LLP
Accountancy firm EIN2016-12-31231551315
2015 : JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$42,941
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$105,829
Total income from all sources (including contributions)2015-12-31$1,284,291
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$981,279
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$612,317
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,284,190
Value of total assets at end of year2015-12-31$556,739
Value of total assets at beginning of year2015-12-31$316,615
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$368,962
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$101
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$101
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$130,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$422,651
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$19,899
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$42,941
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$105,829
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$42,941
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$105,829
Administrative expenses (other) incurred2015-12-31$259,524
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$303,012
Value of net assets at end of year (total assets less liabilities)2015-12-31$513,798
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$210,786
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$513,798
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$210,786
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$210,786
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$841,640
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$612,317
Contract administrator fees2015-12-31$109,438
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31TROUT, EBERSOLE & GROFF, LLP
Accountancy firm EIN2015-12-31231551315
2014 : JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2014 401k financial data
Total income from all sources2014-12-31$1,269,563
Expenses. Total of all expenses incurred2014-12-31$1,058,777
Benefits paid (including direct rollovers)2014-12-31$958,756
Total plan assets at end of year2014-12-31$210,786
Total plan assets at beginning of year2014-12-31$0
Value of fidelity bond covering the plan2014-12-31$500,000
Total contributions received or receivable from participants2014-12-31$200,064
Other income received2014-12-31$29
Net income (gross income less expenses)2014-12-31$210,786
Net plan assets at end of year (total assets less liabilities)2014-12-31$210,786
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$1,069,470
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$100,021

Form 5500 Responses for JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN

2022: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE 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: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE 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: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE 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: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE 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: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH 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: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH 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 – TrustYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement - TrustYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH 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 – TrustYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement - TrustYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH 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 – TrustYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement - TrustYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH 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 benefit arrangement - TrustYes
2009: JACK GIAMBALVO MOTOR CO., INC. EMPLOYEE HEALTH PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – General assets of the sponsorYes
2009-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30400014
Policy instance 1
Insurance contract or identification number30400014
Number of Individuals Covered171
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 $572,611
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 number30400014
Policy instance 1
Insurance contract or identification number30400014
Number of Individuals Covered177
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 $524,508
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 number30400014
Policy instance 1
Insurance contract or identification number30400014
Number of Individuals Covered161
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 $486,620
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 Covered153
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 $444,314
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 Covered150
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 $442,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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