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BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 401k Plan overview

Plan NameBERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN
Plan identification number 501

BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

BERKSHIRE SYSTEMS GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name:BERKSHIRE SYSTEMS GROUP, INC.
Employer identification number (EIN):232218930
NAIC Classification:238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BERKSHIRE SYSTEMS GROUP, 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
5012018-01-01
5012017-01-01JOSEPH J. HNATISHION
5012016-01-01JOSEPH J. HNATISHION
5012015-01-01JOSEPH J. HNATISHION
5012014-01-01JOE HNATISHION

Plan Statistics for BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN

401k plan membership statisitcs for BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN

Measure Date Value
2022: BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0198
Total number of active participants reported on line 7a of the Form 55002022-01-0198
Number of retired or separated participants receiving benefits2022-01-011
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0199
2021: BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0185
Total number of active participants reported on line 7a of the Form 55002021-01-0197
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 participants2021-01-0198
2020: BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0190
Total number of active participants reported on line 7a of the Form 55002020-01-0185
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 participants2020-01-0185
2019: BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0182
Total number of active participants reported on line 7a of the Form 55002019-01-0190
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 participants2019-01-0190
2018: BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0178
Total number of active participants reported on line 7a of the Form 55002018-01-0181
Number of retired or separated participants receiving benefits2018-01-011
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0182
2017: BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0175
Total number of active participants reported on line 7a of the Form 55002017-01-0177
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0178
2016: BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0177
Total number of active participants reported on line 7a of the Form 55002016-01-0174
Number of retired or separated participants receiving benefits2016-01-011
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0175
2015: BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0168
Total number of active participants reported on line 7a of the Form 55002015-01-0176
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 participants2015-01-0177
2014: BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-010
Total number of active participants reported on line 7a of the Form 55002014-01-0168
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 participants2014-01-0168

Financial Data on BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN

Measure Date Value
2022 : BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$65,311
Total plan liabilities at beginning of year2022-12-31$54,331
Total income from all sources2022-12-31$1,329,066
Expenses. Total of all expenses incurred2022-12-31$1,383,923
Benefits paid (including direct rollovers)2022-12-31$590,694
Total plan assets at end of year2022-12-31$456,542
Total plan assets at beginning of year2022-12-31$500,419
Value of fidelity bond covering the plan2022-12-31$50,000
Total contributions received or receivable from participants2022-12-31$215,643
Expenses. Other expenses not covered elsewhere2022-12-31$536,389
Contributions received from other sources (not participants or employers)2022-12-31$5,962
Other income received2022-12-31$1,326
Net income (gross income less expenses)2022-12-31$-54,857
Net plan assets at end of year (total assets less liabilities)2022-12-31$391,231
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$446,088
Total contributions received or receivable from employer(s)2022-12-31$1,106,135
Value of corrective distributions2022-12-31$240,000
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$16,840
2021 : BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$54,331
Total plan liabilities at beginning of year2021-12-31$34,469
Total income from all sources2021-12-31$1,255,467
Expenses. Total of all expenses incurred2021-12-31$1,313,458
Benefits paid (including direct rollovers)2021-12-31$517,418
Total plan assets at end of year2021-12-31$500,419
Total plan assets at beginning of year2021-12-31$538,548
Value of fidelity bond covering the plan2021-12-31$500,000
Total contributions received or receivable from participants2021-12-31$237,132
Expenses. Other expenses not covered elsewhere2021-12-31$518,453
Contributions received from other sources (not participants or employers)2021-12-31$9,219
Other income received2021-12-31$1,393
Net income (gross income less expenses)2021-12-31$-57,991
Net plan assets at end of year (total assets less liabilities)2021-12-31$446,088
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$504,079
Total contributions received or receivable from employer(s)2021-12-31$1,007,723
Value of corrective distributions2021-12-31$240,000
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$37,587
2020 : BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$34,469
Total plan liabilities at beginning of year2020-12-31$69,692
Total income from all sources2020-12-31$1,172,375
Expenses. Total of all expenses incurred2020-12-31$1,136,339
Benefits paid (including direct rollovers)2020-12-31$394,189
Total plan assets at end of year2020-12-31$538,548
Total plan assets at beginning of year2020-12-31$537,735
Value of fidelity bond covering the plan2020-12-31$50,000
Total contributions received or receivable from participants2020-12-31$200,869
Expenses. Other expenses not covered elsewhere2020-12-31$474,554
Contributions received from other sources (not participants or employers)2020-12-31$2,866
Other income received2020-12-31$1,340
Net income (gross income less expenses)2020-12-31$36,036
Net plan assets at end of year (total assets less liabilities)2020-12-31$504,079
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$468,043
Total contributions received or receivable from employer(s)2020-12-31$967,300
Value of corrective distributions2020-12-31$228,000
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$39,596
2019 : BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$69,692
Total plan liabilities at beginning of year2019-12-31$67,167
Total income from all sources2019-12-31$1,180,821
Expenses. Total of all expenses incurred2019-12-31$909,189
Benefits paid (including direct rollovers)2019-12-31$425,664
Total plan assets at end of year2019-12-31$537,735
Total plan assets at beginning of year2019-12-31$263,578
Value of fidelity bond covering the plan2019-12-31$50,000
Total contributions received or receivable from participants2019-12-31$192,398
Expenses. Other expenses not covered elsewhere2019-12-31$398,477
Contributions received from other sources (not participants or employers)2019-12-31$0
Other income received2019-12-31$898
Net income (gross income less expenses)2019-12-31$271,632
Net plan assets at end of year (total assets less liabilities)2019-12-31$468,043
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$196,411
Total contributions received or receivable from employer(s)2019-12-31$987,525
Value of corrective distributions2019-12-31$48,000
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$37,048
2018 : BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$67,167
Total plan liabilities at beginning of year2018-12-31$61,541
Total income from all sources2018-12-31$1,039,312
Expenses. Total of all expenses incurred2018-12-31$985,151
Benefits paid (including direct rollovers)2018-12-31$489,702
Total plan assets at end of year2018-12-31$263,578
Total plan assets at beginning of year2018-12-31$203,791
Value of fidelity bond covering the plan2018-12-31$50,000
Total contributions received or receivable from participants2018-12-31$185,336
Expenses. Other expenses not covered elsewhere2018-12-31$359,104
Contributions received from other sources (not participants or employers)2018-12-31$545
Other income received2018-12-31$643
Net income (gross income less expenses)2018-12-31$54,161
Net plan assets at end of year (total assets less liabilities)2018-12-31$196,411
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$142,250
Total contributions received or receivable from employer(s)2018-12-31$852,788
Value of corrective distributions2018-12-31$103,069
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$33,276
2017 : BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$61,541
Total plan liabilities at beginning of year2017-12-31$62,449
Total income from all sources2017-12-31$1,003,768
Expenses. Total of all expenses incurred2017-12-31$851,623
Benefits paid (including direct rollovers)2017-12-31$493,800
Total plan assets at end of year2017-12-31$203,791
Total plan assets at beginning of year2017-12-31$52,554
Value of fidelity bond covering the plan2017-12-31$50,000
Total contributions received or receivable from participants2017-12-31$182,676
Expenses. Other expenses not covered elsewhere2017-12-31$312,931
Contributions received from other sources (not participants or employers)2017-12-31$14,047
Other income received2017-12-31$270
Net income (gross income less expenses)2017-12-31$152,145
Net plan assets at end of year (total assets less liabilities)2017-12-31$142,250
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$-9,895
Total contributions received or receivable from employer(s)2017-12-31$806,775
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$44,892
2016 : BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$62,449
Total plan liabilities at beginning of year2016-12-31$38,181
Total income from all sources2016-12-31$802,969
Expenses. Total of all expenses incurred2016-12-31$842,965
Benefits paid (including direct rollovers)2016-12-31$497,191
Total plan assets at end of year2016-12-31$52,554
Total plan assets at beginning of year2016-12-31$68,282
Value of fidelity bond covering the plan2016-12-31$50,000
Total contributions received or receivable from participants2016-12-31$156,659
Expenses. Other expenses not covered elsewhere2016-12-31$250,352
Contributions received from other sources (not participants or employers)2016-12-31$8,675
Other income received2016-12-31$64
Net income (gross income less expenses)2016-12-31$-39,996
Net plan assets at end of year (total assets less liabilities)2016-12-31$-9,895
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$30,101
Total contributions received or receivable from employer(s)2016-12-31$637,571
Value of corrective distributions2016-12-31$49,310
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$46,112
2015 : BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$38,181
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$738,709
Expenses. Total of all expenses incurred2015-12-31$822,545
Benefits paid (including direct rollovers)2015-12-31$477,149
Total plan assets at end of year2015-12-31$68,282
Total plan assets at beginning of year2015-12-31$113,937
Value of fidelity bond covering the plan2015-12-31$50,000
Total contributions received or receivable from participants2015-12-31$139,837
Expenses. Other expenses not covered elsewhere2015-12-31$232,640
Contributions received from other sources (not participants or employers)2015-12-31$3,098
Other income received2015-12-31$345
Net income (gross income less expenses)2015-12-31$-83,836
Net plan assets at end of year (total assets less liabilities)2015-12-31$30,101
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$113,937
Total contributions received or receivable from employer(s)2015-12-31$595,429
Value of corrective distributions2015-12-31$69,034
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$43,722
2014 : BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN 2014 401k financial data
Total income from all sources2014-12-31$656,508
Expenses. Total of all expenses incurred2014-12-31$540,571
Total plan assets at end of year2014-12-31$115,937
Value of fidelity bond covering the plan2014-12-31$50,000
Total contributions received or receivable from participants2014-12-31$109,072
Expenses. Other expenses not covered elsewhere2014-12-31$171,525
Other income received2014-12-31$201
Net income (gross income less expenses)2014-12-31$115,937
Net plan assets at end of year (total assets less liabilities)2014-12-31$115,937
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$547,235
Value of corrective distributions2014-12-31$296,106
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$72,940

Form 5500 Responses for BERKSHIRE SYSTEMS GROUP, INC. GROUP MEDICAL PLAN

2022: BERKSHIRE SYSTEMS GROUP, 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 funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: BERKSHIRE SYSTEMS GROUP, 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 funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: BERKSHIRE SYSTEMS GROUP, 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 funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: BERKSHIRE SYSTEMS GROUP, 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: BERKSHIRE SYSTEMS GROUP, 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: BERKSHIRE SYSTEMS GROUP, 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: BERKSHIRE SYSTEMS GROUP, 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: BERKSHIRE SYSTEMS GROUP, 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: BERKSHIRE SYSTEMS GROUP, 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 benefit arrangement - TrustYes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407407
Policy instance 1
Insurance contract or identification number407407
Number of Individuals Covered98
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 $470,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407407
Policy instance 1
Insurance contract or identification number407407
Number of Individuals Covered98
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 $454,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407407
Policy instance 1
Insurance contract or identification number407407
Number of Individuals Covered85
Insurance policy start date2020-01-01
Insurance policy end date2020-01-31
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 $414,467
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 Covered90
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 $344,106
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 Covered77
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 $264,946
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 $125
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 Covered77
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 $190,391
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 Covered68
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 $171,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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