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BROWN SCHULTZ SHERIDAN & FRITZ GROUP HEALTH PLAN 401k Plan overview

Plan NameBROWN SCHULTZ SHERIDAN & FRITZ GROUP HEALTH PLAN
Plan identification number 501

BROWN SCHULTZ SHERIDAN & FRITZ GROUP HEALTH PLAN Benefits

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

401k Sponsoring company profile

BROWN SCHULTZ SHERIDAN & FRITZ has sponsored the creation of one or more 401k plans.

Company Name:BROWN SCHULTZ SHERIDAN & FRITZ
Employer identification number (EIN):251644159
NAIC Classification:541211
NAIC Description:Offices of Certified Public Accountants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BROWN SCHULTZ SHERIDAN & FRITZ GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-06-01
5012017-06-01KENNETH B. WOLFE
5012016-06-01KENNETH B. WOLFE
5012016-01-01KENNETH B. WOLFE
5012015-01-01KENNETH B. WOLFE
5012014-01-01KENNETH B. WOLFE
5012013-01-01KENNETH B. WOLFE
5012012-01-01KENNETH B. WOLFE
5012011-01-01KENNETH B. WOLFE

Plan Statistics for BROWN SCHULTZ SHERIDAN & FRITZ GROUP HEALTH PLAN

401k plan membership statisitcs for BROWN SCHULTZ SHERIDAN & FRITZ GROUP HEALTH PLAN

Measure Date Value
2019
Total participants, beginning-of-year2019-06-0180
Total number of active participants reported on line 7a of the Form 55002019-06-0197
Number of retired or separated participants receiving benefits2019-06-014
Number of other retired or separated participants entitled to future benefits2019-06-010
Total of all active and inactive participants2019-06-01101
2017
Total participants, beginning-of-year2017-06-0174
Total number of active participants reported on line 7a of the Form 55002017-06-0182
Number of retired or separated participants receiving benefits2017-06-011
Number of other retired or separated participants entitled to future benefits2017-06-010
Total of all active and inactive participants2017-06-0183
2016
Total participants, beginning-of-year2016-06-0181
Total number of active participants reported on line 7a of the Form 55002016-06-0173
Number of retired or separated participants receiving benefits2016-06-011
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-0174
Total participants, beginning-of-year2016-01-0181
Total number of active participants reported on line 7a of the Form 55002016-01-0173
Number of retired or separated participants receiving benefits2016-01-012
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0175
2015
Total participants, beginning-of-year2015-01-0179
Total number of active participants reported on line 7a of the Form 55002015-01-0178
Number of retired or separated participants receiving benefits2015-01-013
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0181
2014
Total participants, beginning-of-year2014-01-0177
Total number of active participants reported on line 7a of the Form 55002014-01-0176
Number of retired or separated participants receiving benefits2014-01-013
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0179
2013
Total participants, beginning-of-year2013-01-0178
Total number of active participants reported on line 7a of the Form 55002013-01-0176
Number of retired or separated participants receiving benefits2013-01-011
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0177
2012
Total participants, beginning-of-year2012-01-0194
Total number of active participants reported on line 7a of the Form 55002012-01-0177
Number of retired or separated participants receiving benefits2012-01-011
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0178
2011
Total participants, beginning-of-year2011-01-0194
Total number of active participants reported on line 7a of the Form 55002011-01-0193
Number of retired or separated participants receiving benefits2011-01-011
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0194

Financial Data on BROWN SCHULTZ SHERIDAN & FRITZ GROUP HEALTH PLAN

Measure Date Value
2020
Total plan liabilities at end of year2020-05-31$5,144
Total plan liabilities at beginning of year2020-05-31$6,957
Total income from all sources2020-05-31$809,097
Expenses. Total of all expenses incurred2020-05-31$1,127,493
Benefits paid (including direct rollovers)2020-05-31$559,750
Total plan assets at end of year2020-05-31$261,848
Total plan assets at beginning of year2020-05-31$582,057
Value of fidelity bond covering the plan2020-05-31$200,000
Total contributions received or receivable from participants2020-05-31$250,690
Expenses. Other expenses not covered elsewhere2020-05-31$463,673
Other income received2020-05-31$1,568
Net income (gross income less expenses)2020-05-31$-318,396
Net plan assets at end of year (total assets less liabilities)2020-05-31$256,704
Net plan assets at beginning of year (total assets less liabilities)2020-05-31$575,100
Total contributions received or receivable from employer(s)2020-05-31$556,839
Expenses. Administrative service providers (salaries,fees and commissions)2020-05-31$104,070
2018
Total plan liabilities at end of year2018-05-31$0
Total plan liabilities at beginning of year2018-05-31$3,795
Total income from all sources2018-05-31$787,422
Expenses. Total of all expenses incurred2018-05-31$869,035
Benefits paid (including direct rollovers)2018-05-31$543,418
Total plan assets at end of year2018-05-31$516,983
Total plan assets at beginning of year2018-05-31$602,391
Value of fidelity bond covering the plan2018-05-31$200,000
Total contributions received or receivable from participants2018-05-31$277,374
Expenses. Other expenses not covered elsewhere2018-05-31$247,423
Other income received2018-05-31$1,094
Net income (gross income less expenses)2018-05-31$-81,613
Net plan assets at end of year (total assets less liabilities)2018-05-31$516,983
Net plan assets at beginning of year (total assets less liabilities)2018-05-31$598,596
Total contributions received or receivable from employer(s)2018-05-31$508,954
Expenses. Administrative service providers (salaries,fees and commissions)2018-05-31$78,194
2017
Total plan liabilities at end of year2017-05-31$3,795
Total plan liabilities at beginning of year2017-05-31$6,200
Total income from all sources2017-05-31$1,062,576
Expenses. Total of all expenses incurred2017-05-31$664,712
Benefits paid (including direct rollovers)2017-05-31$382,268
Total plan assets at end of year2017-05-31$602,391
Total plan assets at beginning of year2017-05-31$206,932
Value of fidelity bond covering the plan2017-05-31$200,000
Total contributions received or receivable from participants2017-05-31$292,917
Expenses. Other expenses not covered elsewhere2017-05-31$204,475
Other income received2017-05-31$778
Net income (gross income less expenses)2017-05-31$397,864
Net plan assets at end of year (total assets less liabilities)2017-05-31$598,596
Net plan assets at beginning of year (total assets less liabilities)2017-05-31$200,732
Total contributions received or receivable from employer(s)2017-05-31$768,881
Expenses. Administrative service providers (salaries,fees and commissions)2017-05-31$77,969
2016
Total plan liabilities at end of year2016-05-31$6,200
Total plan liabilities at beginning of year2016-05-31$0
Total income from all sources2016-05-31$391,274
Expenses. Total of all expenses incurred2016-05-31$312,325
Benefits paid (including direct rollovers)2016-05-31$210,454
Total plan assets at end of year2016-05-31$206,932
Total plan assets at beginning of year2016-05-31$121,783
Value of fidelity bond covering the plan2016-05-31$200,000
Total contributions received or receivable from participants2016-05-31$128,082
Expenses. Other expenses not covered elsewhere2016-05-31$70,598
Other income received2016-05-31$123
Net income (gross income less expenses)2016-05-31$78,949
Net plan assets at end of year (total assets less liabilities)2016-05-31$200,732
Net plan assets at beginning of year (total assets less liabilities)2016-05-31$121,783
Total contributions received or receivable from employer(s)2016-05-31$263,069
Expenses. Administrative service providers (salaries,fees and commissions)2016-05-31$31,273
2015
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$24,554
Total income from all sources2015-12-31$914,395
Expenses. Total of all expenses incurred2015-12-31$792,612
Benefits paid (including direct rollovers)2015-12-31$543,897
Total plan assets at end of year2015-12-31$121,783
Total plan assets at beginning of year2015-12-31$24,554
Value of fidelity bond covering the plan2015-12-31$500,000
Total contributions received or receivable from participants2015-12-31$297,146
Expenses. Other expenses not covered elsewhere2015-12-31$173,879
Other income received2015-12-31$146
Net income (gross income less expenses)2015-12-31$121,783
Net plan assets at end of year (total assets less liabilities)2015-12-31$121,783
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$0
Total contributions received or receivable from employer(s)2015-12-31$617,103
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$74,836
2014
Total plan liabilities at end of year2014-12-31$24,554
Total plan liabilities at beginning of year2014-12-31$10,226
Total income from all sources2014-12-31$1,176,786
Expenses. Total of all expenses incurred2014-12-31$1,243,508
Benefits paid (including direct rollovers)2014-12-31$1,015,685
Total plan assets at end of year2014-12-31$24,554
Total plan assets at beginning of year2014-12-31$76,948
Value of fidelity bond covering the plan2014-12-31$200,000
Total contributions received or receivable from participants2014-12-31$242,074
Expenses. Other expenses not covered elsewhere2014-12-31$152,263
Other income received2014-12-31$398,539
Net income (gross income less expenses)2014-12-31$-66,722
Net plan assets at end of year (total assets less liabilities)2014-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$66,722
Total contributions received or receivable from employer(s)2014-12-31$536,173
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$75,560
2013
Total plan liabilities at end of year2013-12-31$10,226
Total plan liabilities at beginning of year2013-12-31$6,462
Total income from all sources2013-12-31$875,415
Expenses. Total of all expenses incurred2013-12-31$839,142
Benefits paid (including direct rollovers)2013-12-31$613,775
Total plan assets at end of year2013-12-31$76,948
Total plan assets at beginning of year2013-12-31$36,911
Value of fidelity bond covering the plan2013-12-31$1,000,000
Total contributions received or receivable from participants2013-12-31$210,569
Expenses. Other expenses not covered elsewhere2013-12-31$150,352
Other income received2013-12-31$225,057
Net income (gross income less expenses)2013-12-31$36,273
Net plan assets at end of year (total assets less liabilities)2013-12-31$66,722
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$30,449
Total contributions received or receivable from employer(s)2013-12-31$439,789
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$75,015
2012
Total plan liabilities at end of year2012-12-31$6,462
Total plan liabilities at beginning of year2012-12-31$26,199
Total income from all sources2012-12-31$625,518
Expenses. Total of all expenses incurred2012-12-31$630,247
Benefits paid (including direct rollovers)2012-12-31$406,454
Total plan assets at end of year2012-12-31$36,911
Total plan assets at beginning of year2012-12-31$61,377
Total contributions received or receivable from participants2012-12-31$227,905
Expenses. Other expenses not covered elsewhere2012-12-31$152,816
Other income received2012-12-31$38,846
Net income (gross income less expenses)2012-12-31$-4,729
Net plan assets at end of year (total assets less liabilities)2012-12-31$30,449
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$35,178
Total contributions received or receivable from employer(s)2012-12-31$358,767
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$70,977
2011
Total plan liabilities at end of year2011-12-31$26,199
Total income from all sources2011-12-31$652,894
Expenses. Total of all expenses incurred2011-12-31$617,716
Benefits paid (including direct rollovers)2011-12-31$405,895
Total plan assets at end of year2011-12-31$61,377
Total contributions received or receivable from participants2011-12-31$217,804
Expenses. Other expenses not covered elsewhere2011-12-31$143,494
Other income received2011-12-31$93,699
Net income (gross income less expenses)2011-12-31$35,178
Net plan assets at end of year (total assets less liabilities)2011-12-31$35,178
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$341,391
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$68,327

Form 5500 Responses

2019
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
2017
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
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
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)Yes
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
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
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract numberGENESIS
Policy instance 1
Insurance contract or identification numberGENESIS
Number of Individuals Covered83
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 $247,424
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: 26921 )
Policy contract numberGENESIS
Policy instance 1
Insurance contract or identification numberGENESIS
Number of Individuals Covered75
Insurance policy start date2016-01-01
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 $70,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGENESIS
Policy instance 1
Insurance contract or identification numberGENESIS
Number of Individuals Covered0
Insurance policy start date2015-01-01
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 $65,921
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: 26921 )
Policy contract numberGENESIS
Policy instance 2
Insurance contract or identification numberGENESIS
Number of Individuals Covered78
Insurance policy start date2015-06-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $103,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGENESIS
Policy instance 1
Insurance contract or identification numberGENESIS
Number of Individuals Covered79
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $152,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGENESIS
Policy instance 1
Insurance contract or identification numberGENESIS
Number of Individuals Covered77
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $150,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGENESIS
Policy instance 1
Insurance contract or identification numberGENESIS
Number of Individuals Covered78
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $152,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGENESIS
Policy instance 1
Insurance contract or identification numberGENESIS
Number of Individuals Covered94
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $212,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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