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MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN 401k Plan overview

Plan NameMILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN
Plan identification number 501

MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

MILLERS CAPITAL INSURANCE COMANY has sponsored the creation of one or more 401k plans.

Company Name:MILLERS CAPITAL INSURANCE COMANY
Employer identification number (EIN):251819197
NAIC Classification:524150

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-10-01
5012019-10-01

Plan Statistics for MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN

401k plan membership statisitcs for MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN

Measure Date Value
2022: MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0167
Total number of active participants reported on line 7a of the Form 55002022-01-0161
Number of retired or separated participants receiving benefits2022-01-012
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0163
2021: MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0161
Total number of active participants reported on line 7a of the Form 55002021-01-0163
Number of retired or separated participants receiving benefits2021-01-014
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0167
2020: MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-0162
Total number of active participants reported on line 7a of the Form 55002020-10-0160
Number of retired or separated participants receiving benefits2020-10-011
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-0161
2019: MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-0165
Total number of active participants reported on line 7a of the Form 55002019-10-0161
Number of retired or separated participants receiving benefits2019-10-011
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-0162

Financial Data on MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN

Measure Date Value
2022 : MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$36,477
Total plan liabilities at beginning of year2022-12-31$88,466
Total income from all sources2022-12-31$657,247
Expenses. Total of all expenses incurred2022-12-31$515,158
Benefits paid (including direct rollovers)2022-12-31$209,049
Total plan assets at end of year2022-12-31$112,801
Total plan assets at beginning of year2022-12-31$22,701
Value of fidelity bond covering the plan2022-12-31$1,000,000
Total contributions received or receivable from participants2022-12-31$149,594
Expenses. Other expenses not covered elsewhere2022-12-31$301,688
Contributions received from other sources (not participants or employers)2022-12-31$13,964
Other income received2022-12-31$242
Noncash contributions received2022-12-31$0
Net income (gross income less expenses)2022-12-31$142,089
Net plan assets at end of year (total assets less liabilities)2022-12-31$76,324
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$-65,765
Total contributions received or receivable from employer(s)2022-12-31$493,447
Value of certain deemed distributions of participant loans2022-12-31$0
Value of corrective distributions2022-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$4,421
2021 : MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$88,466
Total plan liabilities at beginning of year2021-12-31$37,989
Total income from all sources2021-12-31$617,517
Expenses. Total of all expenses incurred2021-12-31$656,281
Benefits paid (including direct rollovers)2021-12-31$355,006
Total plan assets at end of year2021-12-31$22,701
Total plan assets at beginning of year2021-12-31$10,988
Value of fidelity bond covering the plan2021-12-31$1,000,000
Total contributions received or receivable from participants2021-12-31$128,336
Expenses. Other expenses not covered elsewhere2021-12-31$274,619
Contributions received from other sources (not participants or employers)2021-12-31$9,814
Other income received2021-12-31$59
Net income (gross income less expenses)2021-12-31$-38,764
Net plan assets at end of year (total assets less liabilities)2021-12-31$-65,765
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$-27,001
Total contributions received or receivable from employer(s)2021-12-31$479,308
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$26,656
2020 : MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$37,989
Total plan liabilities at beginning of year2020-12-31$27,881
Total income from all sources2020-12-31$106,279
Expenses. Total of all expenses incurred2020-12-31$242,647
Benefits paid (including direct rollovers)2020-12-31$168,570
Total plan assets at end of year2020-12-31$10,988
Total plan assets at beginning of year2020-12-31$137,248
Value of fidelity bond covering the plan2020-12-31$1,000,000
Total contributions received or receivable from participants2020-12-31$35,525
Expenses. Other expenses not covered elsewhere2020-12-31$65,825
Contributions received from other sources (not participants or employers)2020-12-31$1,678
Other income received2020-12-31$32
Net income (gross income less expenses)2020-12-31$-136,368
Net plan assets at end of year (total assets less liabilities)2020-12-31$-27,001
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$109,367
Total contributions received or receivable from employer(s)2020-12-31$69,044
Value of corrective distributions2020-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$8,252
Total plan liabilities at end of year2020-09-30$27,881
Total income from all sources2020-09-30$675,802
Expenses. Total of all expenses incurred2020-09-30$566,435
Benefits paid (including direct rollovers)2020-09-30$269,999
Total plan assets at end of year2020-09-30$137,248
Value of fidelity bond covering the plan2020-09-30$1,000,000
Total contributions received or receivable from participants2020-09-30$145,897
Expenses. Other expenses not covered elsewhere2020-09-30$263,536
Contributions received from other sources (not participants or employers)2020-09-30$6,105
Other income received2020-09-30$170
Net income (gross income less expenses)2020-09-30$109,367
Net plan assets at end of year (total assets less liabilities)2020-09-30$109,367
Net plan assets at beginning of year (total assets less liabilities)2020-09-30$0
Total contributions received or receivable from employer(s)2020-09-30$523,630
Value of corrective distributions2020-09-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-09-30$32,900

Form 5500 Responses for MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN

2022: MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL 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: MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL 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: MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Submission has been amendedNo
2020-10-01This submission is the final filingNo
2020-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-10-01Plan is a collectively bargained planNo
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan funding arrangement – TrustYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement - TrustYes
2019: MILLERS CAPITAL INSURANCE COMPANY GROUP MEDICAL PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01First time form 5500 has been submittedYes
2019-10-01Submission has been amendedNo
2019-10-01This submission is the final filingNo
2019-10-01This return/report is a short plan year return/report (less than 12 months)No
2019-10-01Plan is a collectively bargained planNo
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – TrustYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500479
Policy instance 1
Insurance contract or identification number30500479
Number of Individuals Covered63
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 $263,058
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 number30500479
Policy instance 1
Insurance contract or identification number30500479
Number of Individuals Covered63
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 $235,384
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 number30500479
Policy instance 1
Insurance contract or identification number30500479
Number of Individuals Covered61
Insurance policy start date2020-10-01
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 $56,181
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 number30500479
Policy instance 1
Insurance contract or identification number30500479
Number of Individuals Covered62
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
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 $223,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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