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FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameFOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN
Plan identification number 501

FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

FOX SPECIALTIES INC. DBA ENCOMPASS ELEMENTS has sponsored the creation of one or more 401k plans.

Company Name:FOX SPECIALTIES INC. DBA ENCOMPASS ELEMENTS
Employer identification number (EIN):232800462
NAIC Classification:323100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOX SPECIALTIES, INC. EMPLOYEE BENEFIT 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
5012017-08-01GENE PFEIFFER
5012016-08-01GENE PFEIFFER
5012015-08-01GENE PFEIFFER

Plan Statistics for FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0150
Total number of active participants reported on line 7a of the Form 55002022-01-0156
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 participants2022-01-0156
2021: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0150
Total number of active participants reported on line 7a of the Form 55002021-01-0150
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 participants2021-01-0150
2020: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0150
Total number of active participants reported on line 7a of the Form 55002020-01-0150
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 participants2020-01-0150
2019: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0145
Total number of active participants reported on line 7a of the Form 55002019-01-0150
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 participants2019-01-0150
2018: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0147
Total number of active participants reported on line 7a of the Form 55002018-01-0145
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0145
2017: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-08-0153
Total number of active participants reported on line 7a of the Form 55002017-08-0147
Number of retired or separated participants receiving benefits2017-08-010
Number of other retired or separated participants entitled to future benefits2017-08-010
Total of all active and inactive participants2017-08-0147
2016: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-08-0127
Total number of active participants reported on line 7a of the Form 55002016-08-0153
Number of retired or separated participants receiving benefits2016-08-010
Number of other retired or separated participants entitled to future benefits2016-08-010
Total of all active and inactive participants2016-08-0153
2015: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-0164
Total number of active participants reported on line 7a of the Form 55002015-08-0126
Number of retired or separated participants receiving benefits2015-08-011
Number of other retired or separated participants entitled to future benefits2015-08-010
Total of all active and inactive participants2015-08-0127

Financial Data on FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2022 : FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$62,208
Total plan liabilities at beginning of year2022-12-31$88,365
Total income from all sources2022-12-31$851,448
Expenses. Total of all expenses incurred2022-12-31$728,861
Benefits paid (including direct rollovers)2022-12-31$408,396
Total plan assets at end of year2022-12-31$128,488
Total plan assets at beginning of year2022-12-31$32,058
Value of fidelity bond covering the plan2022-12-31$2,000,000
Total contributions received or receivable from participants2022-12-31$157,500
Expenses. Other expenses not covered elsewhere2022-12-31$268,010
Contributions received from other sources (not participants or employers)2022-12-31$0
Other income received2022-12-31$0
Net income (gross income less expenses)2022-12-31$122,587
Net plan assets at end of year (total assets less liabilities)2022-12-31$66,280
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$-56,307
Total contributions received or receivable from employer(s)2022-12-31$693,948
Value of corrective distributions2022-12-31$27,679
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$24,776
2021 : FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$88,365
Total plan liabilities at beginning of year2021-12-31$37,287
Total income from all sources2021-12-31$780,511
Expenses. Total of all expenses incurred2021-12-31$861,138
Benefits paid (including direct rollovers)2021-12-31$600,903
Total plan assets at end of year2021-12-31$32,058
Total plan assets at beginning of year2021-12-31$61,607
Value of fidelity bond covering the plan2021-12-31$2,000,000
Total contributions received or receivable from participants2021-12-31$151,096
Expenses. Other expenses not covered elsewhere2021-12-31$137,768
Net income (gross income less expenses)2021-12-31$-80,627
Net plan assets at end of year (total assets less liabilities)2021-12-31$-56,307
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$24,320
Total contributions received or receivable from employer(s)2021-12-31$629,415
Value of corrective distributions2021-12-31$99,795
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$22,672
2020 : FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$37,287
Total plan liabilities at beginning of year2020-12-31$45,347
Total income from all sources2020-12-31$805,750
Expenses. Total of all expenses incurred2020-12-31$820,299
Benefits paid (including direct rollovers)2020-12-31$355,221
Total plan assets at end of year2020-12-31$61,607
Total plan assets at beginning of year2020-12-31$84,216
Value of fidelity bond covering the plan2020-12-31$350,000
Total contributions received or receivable from participants2020-12-31$181,053
Expenses. Other expenses not covered elsewhere2020-12-31$337,020
Contributions received from other sources (not participants or employers)2020-12-31$0
Other income received2020-12-31$0
Net income (gross income less expenses)2020-12-31$-14,549
Net plan assets at end of year (total assets less liabilities)2020-12-31$24,320
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$38,869
Total contributions received or receivable from employer(s)2020-12-31$624,697
Value of corrective distributions2020-12-31$105,553
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$22,505
2019 : FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$45,347
Total plan liabilities at beginning of year2019-12-31$179,173
Total income from all sources2019-12-31$673,408
Expenses. Total of all expenses incurred2019-12-31$478,242
Benefits paid (including direct rollovers)2019-12-31$344,679
Total plan assets at end of year2019-12-31$84,216
Total plan assets at beginning of year2019-12-31$22,876
Value of fidelity bond covering the plan2019-12-31$350,000
Total contributions received or receivable from participants2019-12-31$119,723
Expenses. Other expenses not covered elsewhere2019-12-31$113,085
Contributions received from other sources (not participants or employers)2019-12-31$0
Other income received2019-12-31$0
Noncash contributions received2019-12-31$0
Net income (gross income less expenses)2019-12-31$195,166
Net plan assets at end of year (total assets less liabilities)2019-12-31$38,869
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$-156,297
Total contributions received or receivable from employer(s)2019-12-31$553,685
Value of corrective distributions2019-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$20,478
2018 : FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$179,173
Total plan liabilities at beginning of year2018-12-31$204,431
Total income from all sources2018-12-31$569,558
Expenses. Total of all expenses incurred2018-12-31$538,725
Benefits paid (including direct rollovers)2018-12-31$319,670
Total plan assets at end of year2018-12-31$22,876
Total plan assets at beginning of year2018-12-31$17,301
Value of fidelity bond covering the plan2018-12-31$350,000
Total contributions received or receivable from participants2018-12-31$105,561
Expenses. Other expenses not covered elsewhere2018-12-31$200,592
Contributions received from other sources (not participants or employers)2018-12-31$0
Net income (gross income less expenses)2018-12-31$30,833
Net plan assets at end of year (total assets less liabilities)2018-12-31$-156,297
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$-187,130
Total contributions received or receivable from employer(s)2018-12-31$463,997
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$18,463
2017 : FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$204,431
Total plan liabilities at beginning of year2017-12-31$81,657
Total income from all sources2017-12-31$224,747
Expenses. Total of all expenses incurred2017-12-31$333,845
Benefits paid (including direct rollovers)2017-12-31$257,349
Total plan assets at end of year2017-12-31$17,301
Total plan assets at beginning of year2017-12-31$3,625
Value of fidelity bond covering the plan2017-12-31$350,000
Total contributions received or receivable from participants2017-12-31$43,844
Expenses. Other expenses not covered elsewhere2017-12-31$68,249
Net income (gross income less expenses)2017-12-31$-109,098
Net plan assets at end of year (total assets less liabilities)2017-12-31$-187,130
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$-78,032
Total contributions received or receivable from employer(s)2017-12-31$180,903
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$8,247
Total plan liabilities at end of year2017-07-31$81,657
Total plan liabilities at beginning of year2017-07-31$141,814
Total income from all sources2017-07-31$513,595
Expenses. Total of all expenses incurred2017-07-31$484,572
Benefits paid (including direct rollovers)2017-07-31$268,607
Total plan assets at end of year2017-07-31$3,625
Total plan assets at beginning of year2017-07-31$34,759
Value of fidelity bond covering the plan2017-07-31$350,000
Total contributions received or receivable from participants2017-07-31$109,495
Expenses. Other expenses not covered elsewhere2017-07-31$193,960
Contributions received from other sources (not participants or employers)2017-07-31$2,320
Net income (gross income less expenses)2017-07-31$29,023
Net plan assets at end of year (total assets less liabilities)2017-07-31$-78,032
Net plan assets at beginning of year (total assets less liabilities)2017-07-31$-107,055
Total contributions received or receivable from employer(s)2017-07-31$401,780
Expenses. Administrative service providers (salaries,fees and commissions)2017-07-31$22,005
2016 : FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2016 401k financial data
Total plan liabilities at end of year2016-07-31$141,814
Total income from all sources2016-07-31$462,005
Expenses. Total of all expenses incurred2016-07-31$569,060
Benefits paid (including direct rollovers)2016-07-31$394,585
Total plan assets at end of year2016-07-31$34,759
Total plan assets at beginning of year2016-07-31$0
Value of fidelity bond covering the plan2016-07-31$350,000
Total contributions received or receivable from participants2016-07-31$107,011
Expenses. Other expenses not covered elsewhere2016-07-31$150,716
Contributions received from other sources (not participants or employers)2016-07-31$6,118
Net income (gross income less expenses)2016-07-31$-107,055
Net plan assets at end of year (total assets less liabilities)2016-07-31$-107,055
Net plan assets at beginning of year (total assets less liabilities)2016-07-31$0
Total contributions received or receivable from employer(s)2016-07-31$348,876
Expenses. Administrative service providers (salaries,fees and commissions)2016-07-31$23,759

Form 5500 Responses for FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN

2022: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT 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: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT 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: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT 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: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT 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: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT 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: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-08-01Type of plan entitySingle employer plan
2017-08-01Submission has been amendedNo
2017-08-01This submission is the final filingNo
2017-08-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-08-01Plan is a collectively bargained planNo
2017-08-01Plan funding arrangement – InsuranceYes
2017-08-01Plan funding arrangement – TrustYes
2017-08-01Plan benefit arrangement – InsuranceYes
2017-08-01Plan benefit arrangement - TrustYes
2016: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Submission has been amendedNo
2016-08-01This submission is the final filingNo
2016-08-01This return/report is a short plan year return/report (less than 12 months)No
2016-08-01Plan is a collectively bargained planNo
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan funding arrangement – TrustYes
2016-08-01Plan benefit arrangement – InsuranceYes
2016-08-01Plan benefit arrangement - TrustYes
2015: FOX SPECIALTIES, INC. EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01First time form 5500 has been submittedYes
2015-08-01Submission has been amendedNo
2015-08-01This submission is the final filingNo
2015-08-01This return/report is a short plan year return/report (less than 12 months)No
2015-08-01Plan is a collectively bargained planNo
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan funding arrangement – TrustYes
2015-08-01Plan benefit arrangement – InsuranceYes
2015-08-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500136
Policy instance 1
Insurance contract or identification number30500136
Number of Individuals Covered56
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 $232,467
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 number30500136
Policy instance 1
Insurance contract or identification number30500136
Number of Individuals Covered50
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 $194,772
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 number30500136
Policy instance 1
Insurance contract or identification number30500136
Number of Individuals Covered50
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 $191,907
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 Covered50
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 $153,948
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 Covered45
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $135,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered47
Insurance policy start date2017-08-01
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 $53,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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