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AERZEN USA CORP. GROUP MEDICAL PLAN 401k Plan overview

Plan NameAERZEN USA CORP. GROUP MEDICAL PLAN
Plan identification number 502

AERZEN USA CORP. GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

AERZEN USA CORP. has sponsored the creation of one or more 401k plans.

Company Name:AERZEN USA CORP.
Employer identification number (EIN):341384479
NAIC Classification:333200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AERZEN USA CORP. GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-07-01
5022020-07-01
5022019-07-01
5022018-07-01
5022017-07-01KEITH ROLFE
5022016-07-01KEITH ROLFE

Plan Statistics for AERZEN USA CORP. GROUP MEDICAL PLAN

401k plan membership statisitcs for AERZEN USA CORP. GROUP MEDICAL PLAN

Measure Date Value
2021: AERZEN USA CORP. GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-0183
Total number of active participants reported on line 7a of the Form 55002021-07-01137
Number of retired or separated participants receiving benefits2021-07-011
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01138
2020: AERZEN USA CORP. GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01118
Total number of active participants reported on line 7a of the Form 55002020-07-0179
Number of retired or separated participants receiving benefits2020-07-014
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-0183
2019: AERZEN USA CORP. GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01103
Total number of active participants reported on line 7a of the Form 55002019-07-01119
Number of retired or separated participants receiving benefits2019-07-012
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01121
2018: AERZEN USA CORP. GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-0198
Total number of active participants reported on line 7a of the Form 55002018-07-01101
Number of retired or separated participants receiving benefits2018-07-012
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01103
2017: AERZEN USA CORP. GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-0190
Total number of active participants reported on line 7a of the Form 55002017-07-0197
Number of retired or separated participants receiving benefits2017-07-011
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-0198
2016: AERZEN USA CORP. GROUP MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-0190
Total number of active participants reported on line 7a of the Form 55002016-07-0190
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-0190

Financial Data on AERZEN USA CORP. GROUP MEDICAL PLAN

Measure Date Value
2022 : AERZEN USA CORP. GROUP MEDICAL PLAN 2022 401k financial data
Total plan liabilities at end of year2022-06-30$368,769
Total plan liabilities at beginning of year2022-06-30$573,125
Total income from all sources2022-06-30$2,204,426
Expenses. Total of all expenses incurred2022-06-30$1,970,173
Benefits paid (including direct rollovers)2022-06-30$1,299,508
Total plan assets at end of year2022-06-30$312,411
Total plan assets at beginning of year2022-06-30$282,514
Value of fidelity bond covering the plan2022-06-30$500,000
Total contributions received or receivable from participants2022-06-30$142,264
Expenses. Other expenses not covered elsewhere2022-06-30$620,571
Contributions received from other sources (not participants or employers)2022-06-30$12,090
Other income received2022-06-30$551
Net income (gross income less expenses)2022-06-30$234,253
Net plan assets at end of year (total assets less liabilities)2022-06-30$-56,358
Net plan assets at beginning of year (total assets less liabilities)2022-06-30$-290,611
Total contributions received or receivable from employer(s)2022-06-30$2,049,521
Expenses. Administrative service providers (salaries,fees and commissions)2022-06-30$50,094
2021 : AERZEN USA CORP. GROUP MEDICAL PLAN 2021 401k financial data
Total plan liabilities at end of year2021-06-30$573,125
Total plan liabilities at beginning of year2021-06-30$135,002
Total income from all sources2021-06-30$1,870,946
Expenses. Total of all expenses incurred2021-06-30$2,175,368
Benefits paid (including direct rollovers)2021-06-30$1,601,848
Total plan assets at end of year2021-06-30$282,514
Total plan assets at beginning of year2021-06-30$148,813
Value of fidelity bond covering the plan2021-06-30$500,000
Total contributions received or receivable from participants2021-06-30$123,565
Expenses. Other expenses not covered elsewhere2021-06-30$526,126
Contributions received from other sources (not participants or employers)2021-06-30$15,878
Other income received2021-06-30$483
Net income (gross income less expenses)2021-06-30$-304,422
Net plan assets at end of year (total assets less liabilities)2021-06-30$-290,611
Net plan assets at beginning of year (total assets less liabilities)2021-06-30$13,811
Total contributions received or receivable from employer(s)2021-06-30$1,731,020
Expenses. Administrative service providers (salaries,fees and commissions)2021-06-30$47,394
2020 : AERZEN USA CORP. GROUP MEDICAL PLAN 2020 401k financial data
Total plan liabilities at end of year2020-06-30$135,002
Total plan liabilities at beginning of year2020-06-30$104,639
Total income from all sources2020-06-30$1,700,079
Expenses. Total of all expenses incurred2020-06-30$1,636,508
Benefits paid (including direct rollovers)2020-06-30$1,040,007
Total plan assets at end of year2020-06-30$148,813
Total plan assets at beginning of year2020-06-30$54,879
Value of fidelity bond covering the plan2020-06-30$500,000
Total contributions received or receivable from participants2020-06-30$26,935
Expenses. Other expenses not covered elsewhere2020-06-30$466,408
Contributions received from other sources (not participants or employers)2020-06-30$16,125
Other income received2020-06-30$247
Net income (gross income less expenses)2020-06-30$63,571
Net plan assets at end of year (total assets less liabilities)2020-06-30$13,811
Net plan assets at beginning of year (total assets less liabilities)2020-06-30$-49,760
Total contributions received or receivable from employer(s)2020-06-30$1,656,772
Value of corrective distributions2020-06-30$65,832
Expenses. Administrative service providers (salaries,fees and commissions)2020-06-30$64,261
2019 : AERZEN USA CORP. GROUP MEDICAL PLAN 2019 401k financial data
Total plan liabilities at end of year2019-06-30$104,639
Total plan liabilities at beginning of year2019-06-30$88,313
Total income from all sources2019-06-30$1,226,313
Expenses. Total of all expenses incurred2019-06-30$1,378,247
Benefits paid (including direct rollovers)2019-06-30$844,680
Total plan assets at end of year2019-06-30$54,879
Total plan assets at beginning of year2019-06-30$190,487
Value of fidelity bond covering the plan2019-06-30$500,000
Total contributions received or receivable from participants2019-06-30$26,302
Expenses. Other expenses not covered elsewhere2019-06-30$346,272
Contributions received from other sources (not participants or employers)2019-06-30$8,081
Other income received2019-06-30$427
Net income (gross income less expenses)2019-06-30$-151,934
Net plan assets at end of year (total assets less liabilities)2019-06-30$-49,760
Net plan assets at beginning of year (total assets less liabilities)2019-06-30$102,174
Total contributions received or receivable from employer(s)2019-06-30$1,191,503
Value of corrective distributions2019-06-30$135,214
Expenses. Administrative service providers (salaries,fees and commissions)2019-06-30$52,081
2018 : AERZEN USA CORP. GROUP MEDICAL PLAN 2018 401k financial data
Total plan liabilities at end of year2018-06-30$88,313
Total plan liabilities at beginning of year2018-06-30$75,623
Total income from all sources2018-06-30$992,125
Expenses. Total of all expenses incurred2018-06-30$913,515
Benefits paid (including direct rollovers)2018-06-30$566,816
Total plan assets at end of year2018-06-30$190,487
Total plan assets at beginning of year2018-06-30$99,187
Value of fidelity bond covering the plan2018-06-30$500,000
Total contributions received or receivable from participants2018-06-30$21,091
Expenses. Other expenses not covered elsewhere2018-06-30$285,406
Contributions received from other sources (not participants or employers)2018-06-30$661
Other income received2018-06-30$343
Net income (gross income less expenses)2018-06-30$78,610
Net plan assets at end of year (total assets less liabilities)2018-06-30$102,174
Net plan assets at beginning of year (total assets less liabilities)2018-06-30$23,564
Total contributions received or receivable from employer(s)2018-06-30$970,030
Value of corrective distributions2018-06-30$11,748
Expenses. Administrative service providers (salaries,fees and commissions)2018-06-30$49,545
2017 : AERZEN USA CORP. GROUP MEDICAL PLAN 2017 401k financial data
Total plan liabilities at end of year2017-06-30$75,623
Total plan liabilities at beginning of year2017-06-30$0
Total income from all sources2017-06-30$974,791
Expenses. Total of all expenses incurred2017-06-30$951,227
Benefits paid (including direct rollovers)2017-06-30$616,323
Total plan assets at end of year2017-06-30$99,187
Total plan assets at beginning of year2017-06-30$0
Value of fidelity bond covering the plan2017-06-30$500,000
Total contributions received or receivable from participants2017-06-30$21,774
Expenses. Other expenses not covered elsewhere2017-06-30$290,099
Contributions received from other sources (not participants or employers)2017-06-30$4,014
Other income received2017-06-30$82
Noncash contributions received2017-06-30$0
Net income (gross income less expenses)2017-06-30$23,564
Net plan assets at end of year (total assets less liabilities)2017-06-30$23,564
Net plan assets at beginning of year (total assets less liabilities)2017-06-30$0
Total contributions received or receivable from employer(s)2017-06-30$948,921
Expenses. Administrative service providers (salaries,fees and commissions)2017-06-30$44,805

Form 5500 Responses for AERZEN USA CORP. GROUP MEDICAL PLAN

2021: AERZEN USA CORP. GROUP MEDICAL PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2020: AERZEN USA CORP. GROUP MEDICAL PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement - TrustYes
2019: AERZEN USA CORP. GROUP MEDICAL PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – TrustYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement - TrustYes
2018: AERZEN USA CORP. GROUP MEDICAL PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes
2017: AERZEN USA CORP. GROUP MEDICAL PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2016: AERZEN USA CORP. GROUP MEDICAL PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01First time form 5500 has been submittedYes
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberSL30500209
Policy instance 1
Insurance contract or identification numberSL30500209
Number of Individuals Covered137
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
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 $230,166
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 numberSL30500209
Policy instance 1
Insurance contract or identification numberSL30500209
Number of Individuals Covered79
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
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 $447,541
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 numberSL30500209
Policy instance 1
Insurance contract or identification numberSL30500209
Number of Individuals Covered119
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
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 $386,724
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 Covered103
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
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 $283,748
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 Covered98
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
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 $254,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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