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HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 401k Plan overview

Plan NameHYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN
Plan identification number 501

HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN Benefits

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

401k Sponsoring company profile

HYDROWORX INTERNATIONAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:HYDROWORX INTERNATIONAL, INC.
Employer identification number (EIN):251752003
NAIC Classification:238900

Additional information about HYDROWORX INTERNATIONAL, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2016-11-30
Company Identification Number: 0802593447
Legal Registered Office Address: 1420 STONERIDGE DR STE C

MIDDLETOWN
United States of America (USA)
17057

More information about HYDROWORX INTERNATIONAL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN

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

Plan Statistics for HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN

401k plan membership statisitcs for HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN

Measure Date Value
2022: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0136
Total number of active participants reported on line 7a of the Form 55002022-01-0140
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 participants2022-01-0140
2021: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0135
Total number of active participants reported on line 7a of the Form 55002021-01-0140
Number of retired or separated participants receiving benefits2021-01-011
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0141
2020: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0140
Total number of active participants reported on line 7a of the Form 55002020-01-0135
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 participants2020-01-0135
2019: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0140
Total number of active participants reported on line 7a of the Form 55002019-01-0140
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 participants2019-01-0140
2018: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0136
Total number of active participants reported on line 7a of the Form 55002018-01-0139
Number of retired or separated participants receiving benefits2018-01-011
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0140
2017: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-0148
Total number of active participants reported on line 7a of the Form 55002017-06-01856
Number of retired or separated participants receiving benefits2017-06-013
Number of other retired or separated participants entitled to future benefits2017-06-010
Total of all active and inactive participants2017-06-01859
2016: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-0137
Total number of active participants reported on line 7a of the Form 55002016-06-0146
Number of retired or separated participants receiving benefits2016-06-012
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-0148
2015: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-0138
Total number of active participants reported on line 7a of the Form 55002015-06-0137
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 participants2015-06-0137
2014: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-0137
Total number of active participants reported on line 7a of the Form 55002014-06-0138
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 participants2014-06-0138

Financial Data on HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN

Measure Date Value
2022 : HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$32,160
Total plan liabilities at beginning of year2022-12-31$20,863
Total income from all sources2022-12-31$536,845
Expenses. Total of all expenses incurred2022-12-31$502,496
Benefits paid (including direct rollovers)2022-12-31$259,226
Total plan assets at end of year2022-12-31$97,981
Total plan assets at beginning of year2022-12-31$52,335
Value of fidelity bond covering the plan2022-12-31$2,000,000
Total contributions received or receivable from participants2022-12-31$119,499
Expenses. Other expenses not covered elsewhere2022-12-31$210,280
Contributions received from other sources (not participants or employers)2022-12-31$9,377
Other income received2022-12-31$0
Net income (gross income less expenses)2022-12-31$34,349
Net plan assets at end of year (total assets less liabilities)2022-12-31$65,821
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$31,472
Total contributions received or receivable from employer(s)2022-12-31$407,969
Value of corrective distributions2022-12-31$14,817
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$18,173
2021 : HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$20,863
Total plan liabilities at beginning of year2021-12-31$19,180
Total income from all sources2021-12-31$470,138
Expenses. Total of all expenses incurred2021-12-31$533,577
Benefits paid (including direct rollovers)2021-12-31$272,222
Total plan assets at end of year2021-12-31$52,335
Total plan assets at beginning of year2021-12-31$114,091
Value of fidelity bond covering the plan2021-12-31$2,000,000
Total contributions received or receivable from participants2021-12-31$112,550
Expenses. Other expenses not covered elsewhere2021-12-31$172,381
Contributions received from other sources (not participants or employers)2021-12-31$7,129
Net income (gross income less expenses)2021-12-31$-63,439
Net plan assets at end of year (total assets less liabilities)2021-12-31$31,472
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$94,911
Total contributions received or receivable from employer(s)2021-12-31$350,459
Value of corrective distributions2021-12-31$72,334
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$16,640
2020 : HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$19,180
Total plan liabilities at beginning of year2020-12-31$18,640
Total income from all sources2020-12-31$501,115
Expenses. Total of all expenses incurred2020-12-31$612,440
Benefits paid (including direct rollovers)2020-12-31$316,136
Total plan assets at end of year2020-12-31$114,091
Total plan assets at beginning of year2020-12-31$224,876
Value of fidelity bond covering the plan2020-12-31$2,000,000
Total contributions received or receivable from participants2020-12-31$127,961
Expenses. Other expenses not covered elsewhere2020-12-31$190,186
Contributions received from other sources (not participants or employers)2020-12-31$0
Other income received2020-12-31$0
Net income (gross income less expenses)2020-12-31$-111,325
Net plan assets at end of year (total assets less liabilities)2020-12-31$94,911
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$206,236
Total contributions received or receivable from employer(s)2020-12-31$373,154
Value of corrective distributions2020-12-31$86,801
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$19,317
2019 : HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$18,640
Total plan liabilities at beginning of year2019-12-31$22,754
Total income from all sources2019-12-31$462,744
Expenses. Total of all expenses incurred2019-12-31$358,742
Benefits paid (including direct rollovers)2019-12-31$138,539
Total plan assets at end of year2019-12-31$224,876
Total plan assets at beginning of year2019-12-31$124,988
Value of fidelity bond covering the plan2019-12-31$25,000
Total contributions received or receivable from participants2019-12-31$92,208
Expenses. Other expenses not covered elsewhere2019-12-31$149,402
Contributions received from other sources (not participants or employers)2019-12-31$5,028
Other income received2019-12-31$0
Net income (gross income less expenses)2019-12-31$104,002
Net plan assets at end of year (total assets less liabilities)2019-12-31$206,236
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$102,234
Total contributions received or receivable from employer(s)2019-12-31$365,508
Value of corrective distributions2019-12-31$56,445
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$14,356
2018 : HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$22,754
Total plan liabilities at beginning of year2018-12-31$33,933
Total income from all sources2018-12-31$409,371
Expenses. Total of all expenses incurred2018-12-31$317,681
Benefits paid (including direct rollovers)2018-12-31$209,233
Total plan assets at end of year2018-12-31$124,988
Total plan assets at beginning of year2018-12-31$44,477
Value of fidelity bond covering the plan2018-12-31$25,000
Total contributions received or receivable from participants2018-12-31$102,341
Expenses. Other expenses not covered elsewhere2018-12-31$94,506
Contributions received from other sources (not participants or employers)2018-12-31$22,200
Net income (gross income less expenses)2018-12-31$91,690
Net plan assets at end of year (total assets less liabilities)2018-12-31$102,234
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$10,544
Total contributions received or receivable from employer(s)2018-12-31$284,830
Value of corrective distributions2018-12-31$7
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$13,935
2017 : HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$33,933
Total plan liabilities at beginning of year2017-12-31$32,733
Total income from all sources2017-12-31$266,228
Expenses. Total of all expenses incurred2017-12-31$269,697
Benefits paid (including direct rollovers)2017-12-31$160,443
Total plan assets at end of year2017-12-31$44,477
Total plan assets at beginning of year2017-12-31$46,746
Value of fidelity bond covering the plan2017-12-31$25,000
Total contributions received or receivable from participants2017-12-31$14,883
Expenses. Other expenses not covered elsewhere2017-12-31$99,379
Contributions received from other sources (not participants or employers)2017-12-31$23,388
Net income (gross income less expenses)2017-12-31$-3,469
Net plan assets at end of year (total assets less liabilities)2017-12-31$10,544
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$14,013
Total contributions received or receivable from employer(s)2017-12-31$227,957
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$9,875
Total plan liabilities at end of year2017-05-31$32,733
Total plan liabilities at beginning of year2017-05-31$35,429
Total income from all sources2017-05-31$430,822
Expenses. Total of all expenses incurred2017-05-31$416,163
Benefits paid (including direct rollovers)2017-05-31$270,922
Total plan assets at end of year2017-05-31$46,746
Total plan assets at beginning of year2017-05-31$34,783
Value of fidelity bond covering the plan2017-05-31$25,000
Expenses. Other expenses not covered elsewhere2017-05-31$126,830
Contributions received from other sources (not participants or employers)2017-05-31$16,140
Net income (gross income less expenses)2017-05-31$14,659
Net plan assets at end of year (total assets less liabilities)2017-05-31$14,013
Net plan assets at beginning of year (total assets less liabilities)2017-05-31$-646
Total contributions received or receivable from employer(s)2017-05-31$414,682
Expenses. Administrative service providers (salaries,fees and commissions)2017-05-31$18,411
2016 : HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2016 401k financial data
Total plan liabilities at end of year2016-05-31$35,429
Total plan liabilities at beginning of year2016-05-31$27,519
Total income from all sources2016-05-31$296,223
Expenses. Total of all expenses incurred2016-05-31$279,430
Benefits paid (including direct rollovers)2016-05-31$165,771
Total plan assets at end of year2016-05-31$34,783
Total plan assets at beginning of year2016-05-31$10,080
Value of fidelity bond covering the plan2016-05-31$25,000
Total contributions received or receivable from participants2016-05-31$0
Expenses. Other expenses not covered elsewhere2016-05-31$98,513
Contributions received from other sources (not participants or employers)2016-05-31$0
Other income received2016-05-31$63
Net income (gross income less expenses)2016-05-31$16,793
Net plan assets at end of year (total assets less liabilities)2016-05-31$-646
Net plan assets at beginning of year (total assets less liabilities)2016-05-31$-17,439
Total contributions received or receivable from employer(s)2016-05-31$296,160
Expenses. Administrative service providers (salaries,fees and commissions)2016-05-31$15,146
2015 : HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2015 401k financial data
Total plan liabilities at end of year2015-05-31$27,519
Total income from all sources2015-05-31$305,123
Expenses. Total of all expenses incurred2015-05-31$322,562
Benefits paid (including direct rollovers)2015-05-31$213,151
Total plan assets at end of year2015-05-31$10,080
Total contributions received or receivable from participants2015-05-31$0
Expenses. Other expenses not covered elsewhere2015-05-31$93,741
Contributions received from other sources (not participants or employers)2015-05-31$0
Noncash contributions received2015-05-31$19
Net income (gross income less expenses)2015-05-31$-17,439
Net plan assets at end of year (total assets less liabilities)2015-05-31$-17,439
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$305,104
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$15,670

Form 5500 Responses for HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN

2022: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: HYDROWORX INTERNATIONAL, INC. EMPLOYEE HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: HYDROWORX INTERNATIONAL, 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)Yes
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: HYDROWORX INTERNATIONAL, 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: HYDROWORX INTERNATIONAL, 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: HYDROWORX INTERNATIONAL, 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 number30500003
Policy instance 1
Insurance contract or identification number30500003
Number of Individuals Covered40
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 $186,095
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 number30500003
Policy instance 1
Insurance contract or identification number30500003
Number of Individuals Covered40
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 $149,738
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 number30500003
Policy instance 1
Insurance contract or identification number30500003
Number of Individuals Covered35
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 $164,140
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 Covered40
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 $126,025
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 Covered36
Insurance policy start date2017-06-01
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 $60,579
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 Covered37
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 $77,857
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 Covered38
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 $73,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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