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DEACOM, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameDEACOM, INC. EMPLOYEE BENEFIT PLAN
Plan identification number 501

DEACOM, INC. EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

DEACOM INC has sponsored the creation of one or more 401k plans.

Company Name:DEACOM INC
Employer identification number (EIN):232846599
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DEACOM, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-11-01CHRISTINE PHILLIPS2023-05-18
5012020-11-01MICHAEL KICAK2022-08-17
5012019-11-01
5012018-11-01
5012017-11-01
5012016-11-01JAY T. DEAKINS

Plan Statistics for DEACOM, INC. EMPLOYEE BENEFIT PLAN

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

Measure Date Value
2021: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-01187
Total number of active participants reported on line 7a of the Form 55002021-11-010
Number of retired or separated participants receiving benefits2021-11-010
Number of other retired or separated participants entitled to future benefits2021-11-010
Total of all active and inactive participants2021-11-010
Number of employers contributing to the scheme2021-11-010
2020: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-01172
Total number of active participants reported on line 7a of the Form 55002020-11-01184
Number of retired or separated participants receiving benefits2020-11-013
Number of other retired or separated participants entitled to future benefits2020-11-010
Total of all active and inactive participants2020-11-01187
Number of employers contributing to the scheme2020-11-010
2019: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-01133
Total number of active participants reported on line 7a of the Form 55002019-11-01144
Number of retired or separated participants receiving benefits2019-11-012
Number of other retired or separated participants entitled to future benefits2019-11-010
Total of all active and inactive participants2019-11-01146
2018: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-01108
Total number of active participants reported on line 7a of the Form 55002018-11-01127
Number of retired or separated participants receiving benefits2018-11-013
Number of other retired or separated participants entitled to future benefits2018-11-010
Total of all active and inactive participants2018-11-01130
2017: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-0195
Total number of active participants reported on line 7a of the Form 55002017-11-01104
Number of retired or separated participants receiving benefits2017-11-014
Number of other retired or separated participants entitled to future benefits2017-11-010
Total of all active and inactive participants2017-11-01108
2016: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-0180
Total number of active participants reported on line 7a of the Form 55002016-11-0193
Number of retired or separated participants receiving benefits2016-11-012
Number of other retired or separated participants entitled to future benefits2016-11-010
Total of all active and inactive participants2016-11-0195

Financial Data on DEACOM, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2022 : DEACOM, INC. EMPLOYEE BENEFIT PLAN 2022 401k financial data
Total income from all sources (including contributions)2022-07-31$265,935
Total of all expenses incurred2022-07-31$451,294
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-07-31$413,215
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-07-31$265,674
Value of total assets at beginning of year2022-07-31$185,359
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-07-31$38,079
Total interest from all sources2022-07-31$261
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-07-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2022-07-31$0
Administrative expenses professional fees incurred2022-07-31$38,079
Was this plan covered by a fidelity bond2022-07-31Yes
Value of fidelity bond cover2022-07-31$400,000
If this is an individual account plan, was there a blackout period2022-07-31No
Were there any nonexempt tranactions with any party-in-interest2022-07-31No
Contributions received from participants2022-07-31$54,416
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-07-31$149,805
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-07-31$152,920
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-07-31No
Value of net income/loss2022-07-31$-185,359
Value of net assets at end of year (total assets less liabilities)2022-07-31$0
Value of net assets at beginning of year (total assets less liabilities)2022-07-31$185,359
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-07-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-07-31No
Were any leases to which the plan was party in default or uncollectible2022-07-31No
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-07-31$32,439
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-07-31$32,439
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-07-31$261
Expenses. Payments to insurance carriers foe the provision of benefits2022-07-31$53,830
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-07-31No
Was there a failure to transmit to the plan any participant contributions2022-07-31No
Has the plan failed to provide any benefit when due under the plan2022-07-31No
Contributions received in cash from employer2022-07-31$211,258
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-07-31$209,580
Did the plan have assets held for investment2022-07-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-07-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-07-31No
Opinion of an independent qualified public accountant for this plan2022-07-31Unqualified
Accountancy firm name2022-07-31BAKER TILLY US, LLP
Accountancy firm EIN2022-07-31390859910
2021 : DEACOM, INC. EMPLOYEE BENEFIT PLAN 2021 401k financial data
Total income from all sources (including contributions)2021-10-31$1,587,005
Total of all expenses incurred2021-10-31$1,639,014
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-10-31$1,431,259
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-10-31$1,586,654
Value of total assets at end of year2021-10-31$185,359
Value of total assets at beginning of year2021-10-31$237,368
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-10-31$207,755
Total interest from all sources2021-10-31$351
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-10-31No
Administrative expenses professional fees incurred2021-10-31$207,755
Was this plan covered by a fidelity bond2021-10-31Yes
Value of fidelity bond cover2021-10-31$400,000
If this is an individual account plan, was there a blackout period2021-10-31No
Were there any nonexempt tranactions with any party-in-interest2021-10-31No
Contributions received from participants2021-10-31$312,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-10-31$152,920
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-10-31$127,933
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-10-31No
Value of net income/loss2021-10-31$-52,009
Value of net assets at end of year (total assets less liabilities)2021-10-31$185,359
Value of net assets at beginning of year (total assets less liabilities)2021-10-31$237,368
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-10-31No
Were any leases to which the plan was party in default or uncollectible2021-10-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-10-31$32,439
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-10-31$109,435
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-10-31$109,435
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-10-31$351
Expenses. Payments to insurance carriers foe the provision of benefits2021-10-31$323,439
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-10-31No
Was there a failure to transmit to the plan any participant contributions2021-10-31No
Has the plan failed to provide any benefit when due under the plan2021-10-31No
Contributions received in cash from employer2021-10-31$1,274,654
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-10-31$1,107,820
Did the plan have assets held for investment2021-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-10-31No
Opinion of an independent qualified public accountant for this plan2021-10-31Unqualified
Accountancy firm name2021-10-31BAKER TILLY US, LLP
Accountancy firm EIN2021-10-31390859910
2020 : DEACOM, INC. EMPLOYEE BENEFIT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-10-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-10-31$0
Total income from all sources (including contributions)2020-10-31$1,336,931
Total loss/gain on sale of assets2020-10-31$0
Total of all expenses incurred2020-10-31$1,104,761
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-10-31$908,928
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-10-31$1,336,793
Value of total assets at end of year2020-10-31$237,368
Value of total assets at beginning of year2020-10-31$5,198
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-10-31$195,833
Total interest from all sources2020-10-31$138
Total dividends received (eg from common stock, registered investment company shares)2020-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-10-31No
Administrative expenses professional fees incurred2020-10-31$195,833
Was this plan covered by a fidelity bond2020-10-31Yes
Value of fidelity bond cover2020-10-31$400,000
If this is an individual account plan, was there a blackout period2020-10-31No
Were there any nonexempt tranactions with any party-in-interest2020-10-31No
Contributions received from participants2020-10-31$292,953
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-10-31$127,933
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-10-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-10-31No
Value of net income/loss2020-10-31$232,170
Value of net assets at end of year (total assets less liabilities)2020-10-31$237,368
Value of net assets at beginning of year (total assets less liabilities)2020-10-31$5,198
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-10-31No
Were any leases to which the plan was party in default or uncollectible2020-10-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-10-31$109,435
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-10-31$5,198
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-10-31$5,198
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-10-31$138
Expenses. Payments to insurance carriers foe the provision of benefits2020-10-31$259,917
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-10-31No
Was there a failure to transmit to the plan any participant contributions2020-10-31No
Has the plan failed to provide any benefit when due under the plan2020-10-31No
Contributions received in cash from employer2020-10-31$1,043,840
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-10-31$649,011
Did the plan have assets held for investment2020-10-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-10-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-10-31No
Opinion of an independent qualified public accountant for this plan2020-10-31Unqualified
Accountancy firm name2020-10-31BAKER TILLY US, LLP
Accountancy firm EIN2020-10-31390859910
2019 : DEACOM, INC. EMPLOYEE BENEFIT PLAN 2019 401k financial data
Total plan liabilities at end of year2019-10-31$120,547
Total plan liabilities at beginning of year2019-10-31$72,183
Total income from all sources2019-10-31$1,038,087
Expenses. Total of all expenses incurred2019-10-31$1,082,633
Benefits paid (including direct rollovers)2019-10-31$706,828
Total plan assets at end of year2019-10-31$5,198
Total plan assets at beginning of year2019-10-31$1,380
Value of fidelity bond covering the plan2019-10-31$206,383
Total contributions received or receivable from participants2019-10-31$259,928
Expenses. Other expenses not covered elsewhere2019-10-31$305,994
Contributions received from other sources (not participants or employers)2019-10-31$14,213
Other income received2019-10-31$214
Net income (gross income less expenses)2019-10-31$-44,546
Net plan assets at end of year (total assets less liabilities)2019-10-31$-115,349
Net plan assets at beginning of year (total assets less liabilities)2019-10-31$-70,803
Total contributions received or receivable from employer(s)2019-10-31$763,732
Value of corrective distributions2019-10-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2019-10-31$69,811
2017 : DEACOM, INC. EMPLOYEE BENEFIT PLAN 2017 401k financial data
Total plan liabilities at end of year2017-10-31$76,016
Total plan liabilities at beginning of year2017-10-31$0
Total income from all sources2017-10-31$554,893
Expenses. Total of all expenses incurred2017-10-31$629,160
Benefits paid (including direct rollovers)2017-10-31$394,136
Total plan assets at end of year2017-10-31$1,749
Total plan assets at beginning of year2017-10-31$0
Value of fidelity bond covering the plan2017-10-31$206,383
Total contributions received or receivable from participants2017-10-31$270,924
Expenses. Other expenses not covered elsewhere2017-10-31$186,797
Contributions received from other sources (not participants or employers)2017-10-31$10,347
Other income received2017-10-31$9
Net income (gross income less expenses)2017-10-31$-74,267
Net plan assets at end of year (total assets less liabilities)2017-10-31$-74,267
Net plan assets at beginning of year (total assets less liabilities)2017-10-31$0
Total contributions received or receivable from employer(s)2017-10-31$273,613
Expenses. Administrative service providers (salaries,fees and commissions)2017-10-31$48,227

Form 5500 Responses for DEACOM, INC. EMPLOYEE BENEFIT PLAN

2021: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01This submission is the final filingYes
2021-11-01This return/report is a short plan year return/report (less than 12 months)Yes
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan funding arrangement – TrustYes
2021-11-01Plan funding arrangement – General assets of the sponsorYes
2021-11-01Plan benefit arrangement – InsuranceYes
2021-11-01Plan benefit arrangement - TrustYes
2021-11-01Plan benefit arrangement – General assets of the sponsorYes
2020: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-11-01Type of plan entitySingle employer plan
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan funding arrangement – TrustYes
2020-11-01Plan benefit arrangement – InsuranceYes
2020-11-01Plan benefit arrangement - TrustYes
2019: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Submission has been amendedNo
2019-11-01This submission is the final filingNo
2019-11-01This return/report is a short plan year return/report (less than 12 months)No
2019-11-01Plan is a collectively bargained planNo
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan funding arrangement – TrustYes
2019-11-01Plan funding arrangement – General assets of the sponsorYes
2019-11-01Plan benefit arrangement – InsuranceYes
2019-11-01Plan benefit arrangement - TrustYes
2019-11-01Plan benefit arrangement – General assets of the sponsorYes
2018: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Submission has been amendedNo
2018-11-01This submission is the final filingNo
2018-11-01This return/report is a short plan year return/report (less than 12 months)No
2018-11-01Plan is a collectively bargained planNo
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan funding arrangement – TrustYes
2018-11-01Plan funding arrangement – General assets of the sponsorYes
2018-11-01Plan benefit arrangement – InsuranceYes
2018-11-01Plan benefit arrangement - TrustYes
2018-11-01Plan benefit arrangement – General assets of the sponsorYes
2017: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Submission has been amendedNo
2017-11-01This submission is the final filingNo
2017-11-01This return/report is a short plan year return/report (less than 12 months)No
2017-11-01Plan is a collectively bargained planNo
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan funding arrangement – TrustYes
2017-11-01Plan funding arrangement – General assets of the sponsorYes
2017-11-01Plan benefit arrangement – InsuranceYes
2017-11-01Plan benefit arrangement - TrustYes
2017-11-01Plan benefit arrangement – General assets of the sponsorYes
2016: DEACOM, INC. EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01First time form 5500 has been submittedYes
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan funding arrangement – TrustYes
2016-11-01Plan benefit arrangement – InsuranceYes
2016-11-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number00
Policy instance 1
Insurance contract or identification number00
Number of Individuals Covered184
Insurance policy start date2021-11-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $53,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )
Policy contract numberAG000165
Policy instance 1
Insurance contract or identification numberAG000165
Number of Individuals Covered184
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number00
Policy instance 2
Insurance contract or identification number00
Number of Individuals Covered184
Insurance policy start date2020-11-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $47,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number00
Policy instance 3
Insurance contract or identification number00
Number of Individuals Covered184
Insurance policy start date2021-01-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $277,621
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 number30500224
Policy instance 1
Insurance contract or identification number30500224
Number of Individuals Covered146
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
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 $259,917
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 Covered127
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
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 $188,215
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 Covered108
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
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 $164,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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