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J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 401k Plan overview

Plan NameJ.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN
Plan identification number 501

J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN Benefits

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

401k Sponsoring company profile

J.K. MECHANICAL INC. has sponsored the creation of one or more 401k plans.

Company Name:J.K. MECHANICAL INC.
Employer identification number (EIN):232583829
NAIC Classification:238220
NAIC Description:Plumbing, Heating, and Air-Conditioning Contractors

Form 5500 Filing Information

Submission information for form 5500 for 401k plan J.K. MECHANICAL 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
5012018-01-01
5012017-01-01CHRISTOPHER LEAMAN
5012016-01-01CHRISTOPHER LEAMAN
5012015-01-01CHRISTOPHER LEAMAN
5012014-05-01CHRISTOPHER LEAMAN

Plan Statistics for J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN

401k plan membership statisitcs for J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN

Measure Date Value
2022: J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0169
Total number of active participants reported on line 7a of the Form 55002022-01-0184
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 participants2022-01-0184
2021: J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0175
Total number of active participants reported on line 7a of the Form 55002021-01-0169
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 participants2021-01-0169
2020: J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0196
Total number of active participants reported on line 7a of the Form 55002020-01-0175
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 participants2020-01-0175
2019: J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0196
Total number of active participants reported on line 7a of the Form 55002019-01-0196
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 participants2019-01-0196
2018: J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0176
Total number of active participants reported on line 7a of the Form 55002018-01-0183
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 participants2018-01-0184
2017: J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0166
Total number of active participants reported on line 7a of the Form 55002017-01-0176
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 participants2017-01-0176
2016: J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0165
Total number of active participants reported on line 7a of the Form 55002016-01-0166
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 participants2016-01-0166
2015: J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0160
Total number of active participants reported on line 7a of the Form 55002015-01-0165
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0165
2014: J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-0157
Total number of active participants reported on line 7a of the Form 55002014-05-0160
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-0160

Financial Data on J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN

Measure Date Value
2022 : J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$187,808
Total plan liabilities at beginning of year2022-12-31$74,508
Total income from all sources2022-12-31$935,566
Expenses. Total of all expenses incurred2022-12-31$1,058,559
Benefits paid (including direct rollovers)2022-12-31$579,588
Total plan assets at end of year2022-12-31$64,463
Total plan assets at beginning of year2022-12-31$74,156
Value of fidelity bond covering the plan2022-12-31$400,000
Total contributions received or receivable from participants2022-12-31$166,810
Expenses. Other expenses not covered elsewhere2022-12-31$392,217
Contributions received from other sources (not participants or employers)2022-12-31$0
Other income received2022-12-31$222
Net income (gross income less expenses)2022-12-31$-122,993
Net plan assets at end of year (total assets less liabilities)2022-12-31$-123,345
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$-352
Total contributions received or receivable from employer(s)2022-12-31$768,534
Value of corrective distributions2022-12-31$80,000
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$6,754
2021 : J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$74,508
Total plan liabilities at beginning of year2021-12-31$169,635
Total income from all sources2021-12-31$720,752
Expenses. Total of all expenses incurred2021-12-31$588,250
Benefits paid (including direct rollovers)2021-12-31$258,039
Total plan assets at end of year2021-12-31$74,156
Total plan assets at beginning of year2021-12-31$36,781
Value of fidelity bond covering the plan2021-12-31$400,000
Total contributions received or receivable from participants2021-12-31$148,841
Expenses. Other expenses not covered elsewhere2021-12-31$306,118
Other income received2021-12-31$130
Net income (gross income less expenses)2021-12-31$132,502
Net plan assets at end of year (total assets less liabilities)2021-12-31$-352
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$-132,854
Total contributions received or receivable from employer(s)2021-12-31$571,781
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$24,093
2020 : J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$169,635
Total plan liabilities at beginning of year2020-12-31$50,703
Total income from all sources2020-12-31$826,267
Expenses. Total of all expenses incurred2020-12-31$1,029,903
Benefits paid (including direct rollovers)2020-12-31$589,731
Total plan assets at end of year2020-12-31$36,781
Total plan assets at beginning of year2020-12-31$121,485
Value of fidelity bond covering the plan2020-12-31$300,000
Total contributions received or receivable from participants2020-12-31$147,041
Expenses. Other expenses not covered elsewhere2020-12-31$336,534
Contributions received from other sources (not participants or employers)2020-12-31$5,326
Other income received2020-12-31$218
Net income (gross income less expenses)2020-12-31$-203,636
Net plan assets at end of year (total assets less liabilities)2020-12-31$-132,854
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$70,782
Total contributions received or receivable from employer(s)2020-12-31$673,682
Value of corrective distributions2020-12-31$80,527
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$23,111
2019 : J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$50,703
Total plan liabilities at beginning of year2019-12-31$64,192
Total income from all sources2019-12-31$891,578
Expenses. Total of all expenses incurred2019-12-31$1,025,816
Benefits paid (including direct rollovers)2019-12-31$439,466
Total plan assets at end of year2019-12-31$121,485
Total plan assets at beginning of year2019-12-31$269,212
Value of fidelity bond covering the plan2019-12-31$350,000
Total contributions received or receivable from participants2019-12-31$167,274
Expenses. Other expenses not covered elsewhere2019-12-31$335,520
Contributions received from other sources (not participants or employers)2019-12-31$832
Other income received2019-12-31$516
Net income (gross income less expenses)2019-12-31$-134,238
Net plan assets at end of year (total assets less liabilities)2019-12-31$70,782
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$205,020
Total contributions received or receivable from employer(s)2019-12-31$722,956
Value of corrective distributions2019-12-31$224,219
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$26,611
2018 : J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$64,192
Total plan liabilities at beginning of year2018-12-31$32,768
Total income from all sources2018-12-31$780,734
Expenses. Total of all expenses incurred2018-12-31$818,754
Benefits paid (including direct rollovers)2018-12-31$266,443
Total plan assets at end of year2018-12-31$269,212
Total plan assets at beginning of year2018-12-31$275,808
Value of fidelity bond covering the plan2018-12-31$350,000
Total contributions received or receivable from participants2018-12-31$139,705
Expenses. Other expenses not covered elsewhere2018-12-31$276,966
Contributions received from other sources (not participants or employers)2018-12-31$0
Other income received2018-12-31$807
Net income (gross income less expenses)2018-12-31$-38,020
Net plan assets at end of year (total assets less liabilities)2018-12-31$205,020
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$243,040
Total contributions received or receivable from employer(s)2018-12-31$640,222
Value of corrective distributions2018-12-31$245,426
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$29,919
2017 : J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$32,768
Total plan liabilities at beginning of year2017-12-31$35,725
Total income from all sources2017-12-31$782,294
Expenses. Total of all expenses incurred2017-12-31$603,919
Benefits paid (including direct rollovers)2017-12-31$250,541
Total plan assets at end of year2017-12-31$275,808
Total plan assets at beginning of year2017-12-31$100,390
Value of fidelity bond covering the plan2017-12-31$350,000
Total contributions received or receivable from participants2017-12-31$147,120
Expenses. Other expenses not covered elsewhere2017-12-31$242,179
Other income received2017-12-31$403
Net income (gross income less expenses)2017-12-31$178,375
Net plan assets at end of year (total assets less liabilities)2017-12-31$243,040
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$64,665
Total contributions received or receivable from employer(s)2017-12-31$634,771
Value of corrective distributions2017-12-31$74,054
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$37,145
2016 : J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$35,725
Total plan liabilities at beginning of year2016-12-31$26,736
Total income from all sources2016-12-31$597,266
Expenses. Total of all expenses incurred2016-12-31$632,570
Benefits paid (including direct rollovers)2016-12-31$339,304
Total plan assets at end of year2016-12-31$100,390
Total plan assets at beginning of year2016-12-31$126,705
Value of fidelity bond covering the plan2016-12-31$350,000
Total contributions received or receivable from participants2016-12-31$136,945
Expenses. Other expenses not covered elsewhere2016-12-31$175,793
Contributions received from other sources (not participants or employers)2016-12-31$0
Other income received2016-12-31$190
Net income (gross income less expenses)2016-12-31$-35,304
Net plan assets at end of year (total assets less liabilities)2016-12-31$64,665
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$99,969
Total contributions received or receivable from employer(s)2016-12-31$460,131
Value of corrective distributions2016-12-31$83,703
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$33,770
2015 : J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$26,736
Total plan liabilities at beginning of year2015-12-31$25,042
Total income from all sources2015-12-31$683,984
Expenses. Total of all expenses incurred2015-12-31$749,019
Benefits paid (including direct rollovers)2015-12-31$377,904
Total plan assets at end of year2015-12-31$126,705
Total plan assets at beginning of year2015-12-31$190,046
Value of fidelity bond covering the plan2015-12-31$350,000
Total contributions received or receivable from participants2015-12-31$128,913
Expenses. Other expenses not covered elsewhere2015-12-31$195,316
Other income received2015-12-31$490
Net income (gross income less expenses)2015-12-31$-65,035
Net plan assets at end of year (total assets less liabilities)2015-12-31$99,969
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$165,004
Total contributions received or receivable from employer(s)2015-12-31$554,581
Value of corrective distributions2015-12-31$142,129
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$33,670
2014 : J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2014 401k financial data
Total plan liabilities at end of year2014-12-31$25,042
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$298,846
Expenses. Total of all expenses incurred2014-12-31$133,842
Benefits paid (including direct rollovers)2014-12-31$108,800
Total plan assets at end of year2014-12-31$190,046
Total plan assets at beginning of year2014-12-31$0
Value of fidelity bond covering the plan2014-12-31$42,455
Total contributions received or receivable from participants2014-12-31$56,747
Expenses. Other expenses not covered elsewhere2014-12-31$25,042
Other income received2014-12-31$176
Net income (gross income less expenses)2014-12-31$165,004
Net plan assets at end of year (total assets less liabilities)2014-12-31$165,004
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$241,923

Form 5500 Responses for J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN

2022: J.K. MECHANICAL 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: J.K. MECHANICAL 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: J.K. MECHANICAL 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: J.K. MECHANICAL 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: J.K. MECHANICAL 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: J.K. MECHANICAL 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 – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: J.K. MECHANICAL 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 – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: J.K. MECHANICAL 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 – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: J.K. MECHANICAL INC. EMPLOYEE HEALTH PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01First time form 5500 has been submittedYes
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – TrustYes
2014-05-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407357
Policy instance 1
Insurance contract or identification number407357
Number of Individuals Covered69
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 $338,325
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 number407357
Policy instance 1
Insurance contract or identification number407357
Number of Individuals Covered69
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 $282,991
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 number407357
Policy instance 1
Insurance contract or identification number407357
Number of Individuals Covered75
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 $261,804
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 Covered86
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 $277,775
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 Covered76
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 $199,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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