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BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 401k Plan overview

Plan NameBARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN
Plan identification number 501

BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN Benefits

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

401k Sponsoring company profile

BARRYS PAINT SHOP, INC. has sponsored the creation of one or more 401k plans.

Company Name:BARRYS PAINT SHOP, INC.
Employer identification number (EIN):232799406
NAIC Classification:811120
NAIC Description: Automotive Body, Paint, Interior, and Glass Repair

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-06-01
5012021-06-01
5012020-06-01
5012019-06-01
5012018-06-01
5012017-06-01BARRY BURKHOLDER
5012016-06-01BARRY BURKHOLDER
5012015-06-01BARRY BURKHOLDER
5012014-06-01BARRY BURKHOLDER

Plan Statistics for BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN

401k plan membership statisitcs for BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN

Measure Date Value
2022: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-06-0115
Total number of active participants reported on line 7a of the Form 55002022-06-0125
Number of retired or separated participants receiving benefits2022-06-010
Number of other retired or separated participants entitled to future benefits2022-06-010
Total of all active and inactive participants2022-06-0125
2021: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-0123
Total number of active participants reported on line 7a of the Form 55002021-06-0115
Number of retired or separated participants receiving benefits2021-06-010
Number of other retired or separated participants entitled to future benefits2021-06-010
Total of all active and inactive participants2021-06-0115
2020: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-0136
Total number of active participants reported on line 7a of the Form 55002020-06-0123
Number of retired or separated participants receiving benefits2020-06-010
Number of other retired or separated participants entitled to future benefits2020-06-010
Total of all active and inactive participants2020-06-0123
2019: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-0125
Total number of active participants reported on line 7a of the Form 55002019-06-0135
Number of retired or separated participants receiving benefits2019-06-011
Number of other retired or separated participants entitled to future benefits2019-06-010
Total of all active and inactive participants2019-06-0136
2018: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-0123
Total number of active participants reported on line 7a of the Form 55002018-06-0124
Number of retired or separated participants receiving benefits2018-06-011
Number of other retired or separated participants entitled to future benefits2018-06-010
Total of all active and inactive participants2018-06-0125
2017: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-0118
Total number of active participants reported on line 7a of the Form 55002017-06-0123
Number of retired or separated participants receiving benefits2017-06-010
Number of other retired or separated participants entitled to future benefits2017-06-010
Total of all active and inactive participants2017-06-0123
2016: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-0117
Total number of active participants reported on line 7a of the Form 55002016-06-0118
Number of retired or separated participants receiving benefits2016-06-010
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-0118
2015: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-0122
Total number of active participants reported on line 7a of the Form 55002015-06-0117
Number of retired or separated participants receiving benefits2015-06-010
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-0117
2014: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-0121
Total number of active participants reported on line 7a of the Form 55002014-06-0122
Number of retired or separated participants receiving benefits2014-06-010
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-0122

Financial Data on BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN

Measure Date Value
2023 : BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2023 401k financial data
Total plan liabilities at end of year2023-05-31$45,566
Total plan liabilities at beginning of year2023-05-31$14,506
Total income from all sources2023-05-31$265,501
Expenses. Total of all expenses incurred2023-05-31$215,931
Benefits paid (including direct rollovers)2023-05-31$105,853
Total plan assets at end of year2023-05-31$113,617
Total plan assets at beginning of year2023-05-31$32,987
Value of fidelity bond covering the plan2023-05-31$75,000
Total contributions received or receivable from participants2023-05-31$18,489
Expenses. Other expenses not covered elsewhere2023-05-31$110,078
Contributions received from other sources (not participants or employers)2023-05-31$0
Other income received2023-05-31$395
Net income (gross income less expenses)2023-05-31$49,570
Net plan assets at end of year (total assets less liabilities)2023-05-31$68,051
Net plan assets at beginning of year (total assets less liabilities)2023-05-31$18,481
Total contributions received or receivable from employer(s)2023-05-31$246,617
Value of corrective distributions2023-05-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2023-05-31$0
2022 : BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2022 401k financial data
Total plan liabilities at end of year2022-05-31$14,506
Total plan liabilities at beginning of year2022-05-31$14,620
Total income from all sources2022-05-31$231,088
Expenses. Total of all expenses incurred2022-05-31$263,735
Benefits paid (including direct rollovers)2022-05-31$114,417
Total plan assets at end of year2022-05-31$32,987
Total plan assets at beginning of year2022-05-31$65,748
Value of fidelity bond covering the plan2022-05-31$75,000
Total contributions received or receivable from participants2022-05-31$38,993
Expenses. Other expenses not covered elsewhere2022-05-31$92,106
Net income (gross income less expenses)2022-05-31$-32,647
Net plan assets at end of year (total assets less liabilities)2022-05-31$18,481
Net plan assets at beginning of year (total assets less liabilities)2022-05-31$51,128
Total contributions received or receivable from employer(s)2022-05-31$192,095
Value of corrective distributions2022-05-31$48,517
Expenses. Administrative service providers (salaries,fees and commissions)2022-05-31$8,695
2021 : BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2021 401k financial data
Total plan liabilities at end of year2021-05-31$14,620
Total plan liabilities at beginning of year2021-05-31$12,892
Total income from all sources2021-05-31$244,500
Expenses. Total of all expenses incurred2021-05-31$222,843
Benefits paid (including direct rollovers)2021-05-31$128,286
Total plan assets at end of year2021-05-31$65,748
Total plan assets at beginning of year2021-05-31$42,363
Value of fidelity bond covering the plan2021-05-31$75,000
Total contributions received or receivable from participants2021-05-31$40,941
Expenses. Other expenses not covered elsewhere2021-05-31$84,977
Contributions received from other sources (not participants or employers)2021-05-31$3,672
Net income (gross income less expenses)2021-05-31$21,657
Net plan assets at end of year (total assets less liabilities)2021-05-31$51,128
Net plan assets at beginning of year (total assets less liabilities)2021-05-31$29,471
Total contributions received or receivable from employer(s)2021-05-31$199,887
Expenses. Administrative service providers (salaries,fees and commissions)2021-05-31$9,580
2020 : BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2020 401k financial data
Total plan liabilities at end of year2020-05-31$12,892
Total plan liabilities at beginning of year2020-05-31$11,491
Total income from all sources2020-05-31$274,443
Expenses. Total of all expenses incurred2020-05-31$299,120
Benefits paid (including direct rollovers)2020-05-31$149,195
Total plan assets at end of year2020-05-31$42,363
Total plan assets at beginning of year2020-05-31$65,639
Value of fidelity bond covering the plan2020-05-31$75,000
Total contributions received or receivable from participants2020-05-31$37,274
Expenses. Other expenses not covered elsewhere2020-05-31$108,957
Contributions received from other sources (not participants or employers)2020-05-31$6,180
Other income received2020-05-31$0
Net income (gross income less expenses)2020-05-31$-24,677
Net plan assets at end of year (total assets less liabilities)2020-05-31$29,471
Net plan assets at beginning of year (total assets less liabilities)2020-05-31$54,148
Total contributions received or receivable from employer(s)2020-05-31$230,989
Value of corrective distributions2020-05-31$29,370
Expenses. Administrative service providers (salaries,fees and commissions)2020-05-31$11,598
2018 : BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2018 401k financial data
Total plan liabilities at end of year2018-05-31$9,078
Total plan liabilities at beginning of year2018-05-31$8,116
Total income from all sources2018-05-31$149,865
Expenses. Total of all expenses incurred2018-05-31$144,996
Benefits paid (including direct rollovers)2018-05-31$70,154
Total plan assets at end of year2018-05-31$34,867
Total plan assets at beginning of year2018-05-31$29,036
Value of fidelity bond covering the plan2018-05-31$75,000
Total contributions received or receivable from participants2018-05-31$21,255
Expenses. Other expenses not covered elsewhere2018-05-31$49,873
Net income (gross income less expenses)2018-05-31$4,869
Net plan assets at end of year (total assets less liabilities)2018-05-31$25,789
Net plan assets at beginning of year (total assets less liabilities)2018-05-31$20,920
Total contributions received or receivable from employer(s)2018-05-31$128,610
Value of corrective distributions2018-05-31$16,830
Expenses. Administrative service providers (salaries,fees and commissions)2018-05-31$8,139
2017 : BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2017 401k financial data
Total plan liabilities at end of year2017-05-31$8,116
Total plan liabilities at beginning of year2017-05-31$8,340
Total income from all sources2017-05-31$161,242
Expenses. Total of all expenses incurred2017-05-31$193,657
Benefits paid (including direct rollovers)2017-05-31$117,142
Total plan assets at end of year2017-05-31$29,036
Total plan assets at beginning of year2017-05-31$61,675
Value of fidelity bond covering the plan2017-05-31$75,000
Total contributions received or receivable from participants2017-05-31$18,738
Expenses. Other expenses not covered elsewhere2017-05-31$51,363
Contributions received from other sources (not participants or employers)2017-05-31$0
Net income (gross income less expenses)2017-05-31$-32,415
Net plan assets at end of year (total assets less liabilities)2017-05-31$20,920
Net plan assets at beginning of year (total assets less liabilities)2017-05-31$53,335
Total contributions received or receivable from employer(s)2017-05-31$142,504
Value of corrective distributions2017-05-31$16,059
Expenses. Administrative service providers (salaries,fees and commissions)2017-05-31$9,093
2016 : BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2016 401k financial data
Total plan liabilities at end of year2016-05-31$8,340
Total plan liabilities at beginning of year2016-05-31$8,097
Total income from all sources2016-05-31$137,356
Expenses. Total of all expenses incurred2016-05-31$84,916
Benefits paid (including direct rollovers)2016-05-31$28,345
Total plan assets at end of year2016-05-31$61,675
Total plan assets at beginning of year2016-05-31$8,992
Value of fidelity bond covering the plan2016-05-31$75,000
Total contributions received or receivable from participants2016-05-31$18,240
Expenses. Other expenses not covered elsewhere2016-05-31$47,737
Other income received2016-05-31$41
Net income (gross income less expenses)2016-05-31$52,440
Net plan assets at end of year (total assets less liabilities)2016-05-31$53,335
Net plan assets at beginning of year (total assets less liabilities)2016-05-31$895
Total contributions received or receivable from employer(s)2016-05-31$119,075
Expenses. Administrative service providers (salaries,fees and commissions)2016-05-31$8,834
2015 : BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2015 401k financial data
Total plan liabilities at end of year2015-05-31$8,097
Total income from all sources2015-05-31$130,131
Expenses. Total of all expenses incurred2015-05-31$129,236
Benefits paid (including direct rollovers)2015-05-31$67,818
Total plan assets at end of year2015-05-31$8,992
Value of fidelity bond covering the plan2015-05-31$75,000
Total contributions received or receivable from participants2015-05-31$18,822
Expenses. Other expenses not covered elsewhere2015-05-31$51,417
Other income received2015-05-31$8
Noncash contributions received2015-05-31$0
Net income (gross income less expenses)2015-05-31$895
Net plan assets at end of year (total assets less liabilities)2015-05-31$895
Net plan assets at beginning of year (total assets less liabilities)2015-05-31$0
Total contributions received or receivable from employer(s)2015-05-31$111,301
Value of certain deemed distributions of participant loans2015-05-31$0
Value of corrective distributions2015-05-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-05-31$10,001

Form 5500 Responses for BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN

2022: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2022 form 5500 responses
2022-06-01Type of plan entitySingle employer plan
2022-06-01Submission has been amendedNo
2022-06-01This submission is the final filingNo
2022-06-01This return/report is a short plan year return/report (less than 12 months)No
2022-06-01Plan is a collectively bargained planNo
2022-06-01Plan funding arrangement – InsuranceYes
2022-06-01Plan funding arrangement – TrustYes
2022-06-01Plan benefit arrangement – InsuranceYes
2022-06-01Plan benefit arrangement - TrustYes
2021: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Submission has been amendedNo
2021-06-01This submission is the final filingNo
2021-06-01This return/report is a short plan year return/report (less than 12 months)No
2021-06-01Plan is a collectively bargained planNo
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan funding arrangement – TrustYes
2021-06-01Plan benefit arrangement – InsuranceYes
2021-06-01Plan benefit arrangement - TrustYes
2020: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Submission has been amendedNo
2020-06-01This submission is the final filingNo
2020-06-01This return/report is a short plan year return/report (less than 12 months)No
2020-06-01Plan is a collectively bargained planNo
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan funding arrangement – TrustYes
2020-06-01Plan benefit arrangement – InsuranceYes
2020-06-01Plan benefit arrangement - TrustYes
2019: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Submission has been amendedNo
2019-06-01This submission is the final filingNo
2019-06-01This return/report is a short plan year return/report (less than 12 months)No
2019-06-01Plan is a collectively bargained planNo
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan funding arrangement – TrustYes
2019-06-01Plan benefit arrangement – InsuranceYes
2019-06-01Plan benefit arrangement - TrustYes
2018: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Submission has been amendedNo
2018-06-01This submission is the final filingNo
2018-06-01This return/report is a short plan year return/report (less than 12 months)No
2018-06-01Plan is a collectively bargained planNo
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan funding arrangement – TrustYes
2018-06-01Plan benefit arrangement – InsuranceYes
2018-06-01Plan benefit arrangement - TrustYes
2017: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Submission has been amendedNo
2017-06-01This submission is the final filingNo
2017-06-01This return/report is a short plan year return/report (less than 12 months)No
2017-06-01Plan is a collectively bargained planNo
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan funding arrangement – TrustYes
2017-06-01Plan benefit arrangement – InsuranceYes
2017-06-01Plan benefit arrangement - TrustYes
2016: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planNo
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – TrustYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-06-01Plan benefit arrangement - TrustYes
2015: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingNo
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planNo
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – TrustYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-06-01Plan benefit arrangement - TrustYes
2014: BARRY'S PAINT SHOP, INC. EMPLOYEE HEALTH PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01First time form 5500 has been submittedYes
2014-06-01Submission has been amendedNo
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planNo
2014-06-01Plan funding arrangement – TrustYes
2014-06-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500002
Policy instance 1
Insurance contract or identification number30500002
Number of Individuals Covered21
Insurance policy start date2022-06-01
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 $51,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-203372
Policy instance 2
Insurance contract or identification numberUNI-203372
Number of Individuals Covered25
Insurance policy start date2023-01-01
Insurance policy end date2023-05-31
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 $44,378
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 numberSL30500002
Policy instance 1
Insurance contract or identification numberSL30500002
Number of Individuals Covered15
Insurance policy start date2021-06-01
Insurance policy end date2022-05-31
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 $79,554
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 numberSL30500002
Policy instance 1
Insurance contract or identification numberSL30500002
Number of Individuals Covered23
Insurance policy start date2020-06-01
Insurance policy end date2021-05-31
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 $81,462
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 numberSL30500002
Policy instance 1
Insurance contract or identification numberSL30500002
Number of Individuals Covered35
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
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 $83,099
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 Covered24
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
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 $69,061
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 Covered23
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
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 $42,801
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 Covered17
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
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 $37,078
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 Covered22
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
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 $40,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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