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BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameBRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN
Plan identification number 501

BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

BRANDYWINE UROLOGY CONSULTANTS, P.A. has sponsored the creation of one or more 401k plans.

Company Name:BRANDYWINE UROLOGY CONSULTANTS, P.A.
Employer identification number (EIN):510327125
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT 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
5012017-01-01NATHAN DILLER
5012016-01-01MARC PORTMAN
5012015-12-01MARC PORTMAN
5012014-12-01MARC PORTMAN

Plan Statistics for BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0151
Total number of active participants reported on line 7a of the Form 55002022-01-0151
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 participants2022-01-0151
2021: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0148
Total number of active participants reported on line 7a of the Form 55002021-01-0145
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 participants2021-01-0146
2020: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0141
Total number of active participants reported on line 7a of the Form 55002020-01-0148
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 participants2020-01-0148
2019: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0139
Total number of active participants reported on line 7a of the Form 55002019-01-0141
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 participants2019-01-0141
2018: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0132
Total number of active participants reported on line 7a of the Form 55002018-01-0139
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0139
2017: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0137
Total number of active participants reported on line 7a of the Form 55002017-01-0132
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0132
2016: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0134
Total number of active participants reported on line 7a of the Form 55002016-01-0136
Number of retired or separated participants receiving benefits2016-01-011
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0137
2015: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-0135
Total number of active participants reported on line 7a of the Form 55002015-12-0134
Number of retired or separated participants receiving benefits2015-12-010
Number of other retired or separated participants entitled to future benefits2015-12-010
Total of all active and inactive participants2015-12-0134
2014: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-0136
Total number of active participants reported on line 7a of the Form 55002014-12-0135
Number of retired or separated participants receiving benefits2014-12-010
Number of other retired or separated participants entitled to future benefits2014-12-010
Total of all active and inactive participants2014-12-0135

Financial Data on BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN

Measure Date Value
2022 : BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$93,800
Total plan liabilities at beginning of year2022-12-31$33,998
Total income from all sources2022-12-31$834,203
Expenses. Total of all expenses incurred2022-12-31$972,898
Benefits paid (including direct rollovers)2022-12-31$542,626
Total plan assets at end of year2022-12-31$28,019
Total plan assets at beginning of year2022-12-31$106,912
Value of fidelity bond covering the plan2022-12-31$200,000
Total contributions received or receivable from participants2022-12-31$170,945
Expenses. Other expenses not covered elsewhere2022-12-31$324,197
Contributions received from other sources (not participants or employers)2022-12-31$966
Other income received2022-12-31$0
Net income (gross income less expenses)2022-12-31$-138,695
Net plan assets at end of year (total assets less liabilities)2022-12-31$-65,781
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$72,914
Total contributions received or receivable from employer(s)2022-12-31$662,292
Value of corrective distributions2022-12-31$96,624
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$9,451
2021 : BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$33,998
Total plan liabilities at beginning of year2021-12-31$42,872
Total income from all sources2021-12-31$750,608
Expenses. Total of all expenses incurred2021-12-31$801,729
Benefits paid (including direct rollovers)2021-12-31$412,322
Total plan assets at end of year2021-12-31$106,912
Total plan assets at beginning of year2021-12-31$166,907
Value of fidelity bond covering the plan2021-12-31$200,000
Total contributions received or receivable from participants2021-12-31$135,449
Expenses. Other expenses not covered elsewhere2021-12-31$275,492
Contributions received from other sources (not participants or employers)2021-12-31$1,054
Net income (gross income less expenses)2021-12-31$-51,121
Net plan assets at end of year (total assets less liabilities)2021-12-31$72,914
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$124,035
Total contributions received or receivable from employer(s)2021-12-31$614,105
Value of corrective distributions2021-12-31$90,475
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$23,440
2020 : BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$42,872
Total plan liabilities at beginning of year2020-12-31$36,053
Total income from all sources2020-12-31$783,691
Expenses. Total of all expenses incurred2020-12-31$756,454
Benefits paid (including direct rollovers)2020-12-31$387,092
Total plan assets at end of year2020-12-31$166,907
Total plan assets at beginning of year2020-12-31$132,851
Value of fidelity bond covering the plan2020-12-31$200,000
Total contributions received or receivable from participants2020-12-31$141,732
Expenses. Other expenses not covered elsewhere2020-12-31$273,053
Contributions received from other sources (not participants or employers)2020-12-31$1,576
Other income received2020-12-31$0
Net income (gross income less expenses)2020-12-31$27,237
Net plan assets at end of year (total assets less liabilities)2020-12-31$124,035
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$96,798
Total contributions received or receivable from employer(s)2020-12-31$640,383
Value of corrective distributions2020-12-31$75,934
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$20,375
2019 : BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$36,053
Total plan liabilities at beginning of year2019-12-31$27,822
Total income from all sources2019-12-31$676,589
Expenses. Total of all expenses incurred2019-12-31$578,470
Benefits paid (including direct rollovers)2019-12-31$301,400
Total plan assets at end of year2019-12-31$132,851
Total plan assets at beginning of year2019-12-31$26,501
Value of fidelity bond covering the plan2019-12-31$200,000
Total contributions received or receivable from participants2019-12-31$128,310
Expenses. Other expenses not covered elsewhere2019-12-31$223,251
Contributions received from other sources (not participants or employers)2019-12-31$0
Other income received2019-12-31$0
Noncash contributions received2019-12-31$0
Net income (gross income less expenses)2019-12-31$98,119
Net plan assets at end of year (total assets less liabilities)2019-12-31$96,798
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$-1,321
Total contributions received or receivable from employer(s)2019-12-31$548,279
Value of certain deemed distributions of participant loans2019-12-31$0
Value of corrective distributions2019-12-31$34,215
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$19,604
2018 : BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$27,822
Total plan liabilities at beginning of year2018-12-31$25,115
Total income from all sources2018-12-31$565,812
Expenses. Total of all expenses incurred2018-12-31$625,781
Benefits paid (including direct rollovers)2018-12-31$389,161
Total plan assets at end of year2018-12-31$26,501
Total plan assets at beginning of year2018-12-31$83,763
Value of fidelity bond covering the plan2018-12-31$200,000
Total contributions received or receivable from participants2018-12-31$126,597
Expenses. Other expenses not covered elsewhere2018-12-31$182,763
Contributions received from other sources (not participants or employers)2018-12-31$0
Net income (gross income less expenses)2018-12-31$-59,969
Net plan assets at end of year (total assets less liabilities)2018-12-31$-1,321
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$58,648
Total contributions received or receivable from employer(s)2018-12-31$439,215
Value of corrective distributions2018-12-31$35,627
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$18,230
2017 : BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$25,115
Total plan liabilities at beginning of year2017-12-31$39,778
Total income from all sources2017-12-31$459,741
Expenses. Total of all expenses incurred2017-12-31$370,226
Benefits paid (including direct rollovers)2017-12-31$199,286
Total plan assets at end of year2017-12-31$83,763
Total plan assets at beginning of year2017-12-31$8,911
Value of fidelity bond covering the plan2017-12-31$200,000
Total contributions received or receivable from participants2017-12-31$70,627
Expenses. Other expenses not covered elsewhere2017-12-31$153,617
Net income (gross income less expenses)2017-12-31$89,515
Net plan assets at end of year (total assets less liabilities)2017-12-31$58,648
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$-30,867
Total contributions received or receivable from employer(s)2017-12-31$389,114
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$17,323
2016 : BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$39,778
Total plan liabilities at beginning of year2016-12-31$22,601
Total income from all sources2016-12-31$379,214
Expenses. Total of all expenses incurred2016-12-31$388,704
Benefits paid (including direct rollovers)2016-12-31$231,216
Total plan assets at end of year2016-12-31$8,911
Total plan assets at beginning of year2016-12-31$1,224
Value of fidelity bond covering the plan2016-12-31$200,000
Total contributions received or receivable from participants2016-12-31$76,467
Expenses. Other expenses not covered elsewhere2016-12-31$139,490
Contributions received from other sources (not participants or employers)2016-12-31$6,398
Other income received2016-12-31$2
Net income (gross income less expenses)2016-12-31$-9,490
Net plan assets at end of year (total assets less liabilities)2016-12-31$-30,867
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$-21,377
Total contributions received or receivable from employer(s)2016-12-31$296,347
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$17,998
2015 : BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$22,601
Total plan liabilities at beginning of year2015-12-31$25,538
Total income from all sources2015-12-31$25,637
Expenses. Total of all expenses incurred2015-12-31$22,802
Benefits paid (including direct rollovers)2015-12-31$12,363
Total plan assets at end of year2015-12-31$1,224
Total plan assets at beginning of year2015-12-31$1,326
Value of fidelity bond covering the plan2015-12-31$200,000
Total contributions received or receivable from participants2015-12-31$4,611
Expenses. Other expenses not covered elsewhere2015-12-31$9,143
Other income received2015-12-31$1
Net income (gross income less expenses)2015-12-31$2,835
Net plan assets at end of year (total assets less liabilities)2015-12-31$-21,377
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$-24,212
Total contributions received or receivable from employer(s)2015-12-31$21,025
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$1,296
Total plan liabilities at end of year2015-11-30$25,538
Total plan liabilities at beginning of year2015-11-30$0
Total income from all sources2015-11-30$278,661
Expenses. Total of all expenses incurred2015-11-30$302,873
Benefits paid (including direct rollovers)2015-11-30$184,143
Total plan assets at end of year2015-11-30$1,326
Total plan assets at beginning of year2015-11-30$0
Value of fidelity bond covering the plan2015-11-30$200,000
Total contributions received or receivable from participants2015-11-30$55,332
Expenses. Other expenses not covered elsewhere2015-11-30$104,827
Contributions received from other sources (not participants or employers)2015-11-30$0
Other income received2015-11-30$7
Net income (gross income less expenses)2015-11-30$-24,212
Net plan assets at end of year (total assets less liabilities)2015-11-30$-24,212
Net plan assets at beginning of year (total assets less liabilities)2015-11-30$0
Total contributions received or receivable from employer(s)2015-11-30$223,322
Expenses. Administrative service providers (salaries,fees and commissions)2015-11-30$13,903

Form 5500 Responses for BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN

2022: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT 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: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT 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: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT 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: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT 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: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT 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: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
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)No
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: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan funding arrangement – TrustYes
2015-12-01Plan benefit arrangement – InsuranceYes
2015-12-01Plan benefit arrangement - TrustYes
2014: BRANDYWINE UROLOGY CONSULTANTS EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01First time form 5500 has been submittedYes
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingNo
2014-12-01This return/report is a short plan year return/report (less than 12 months)No
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan funding arrangement – TrustYes
2014-12-01Plan benefit arrangement – InsuranceYes
2014-12-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number30500030
Policy instance 1
Insurance contract or identification number30500030
Number of Individuals Covered46
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 $284,741
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 number30500030
Policy instance 1
Insurance contract or identification number30500030
Number of Individuals Covered46
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 $239,367
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 number30500030
Policy instance 1
Insurance contract or identification number30500030
Number of Individuals Covered48
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 $238,496
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 Covered41
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 $192,247
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 Covered32
Insurance policy start date2017-01-01
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 $125,625
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 Covered34
Insurance policy start date2015-12-01
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 $7,142
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 Covered35
Insurance policy start date2014-12-01
Insurance policy end date2015-11-30
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 $81,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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