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ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 401k Plan overview

Plan NameENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN
Plan identification number 502

ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

ENGLE-HAMBRIGHT & DAVIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:ENGLE-HAMBRIGHT & DAVIES, INC.
Employer identification number (EIN):230558310
NAIC Classification:524210
NAIC Description:Insurance Agencies and Brokerages

Additional information about ENGLE-HAMBRIGHT & DAVIES, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2017-05-03
Company Identification Number: 0802713569
Legal Registered Office Address: PO BOX 11600

LANCASTER
United States of America (USA)
17605

More information about ENGLE-HAMBRIGHT & DAVIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022023-01-01
5022022-01-01
5022021-01-01
5022020-01-01
5022019-01-01
5022018-01-01
5022017-01-01LEANNE GORSUCH

Plan Statistics for ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN

401k plan membership statisitcs for ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN

Measure Date Value
2023: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01108
Total number of active participants reported on line 7a of the Form 55002023-01-01119
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01119
2022: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01108
Total number of active participants reported on line 7a of the Form 55002022-01-01108
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 participants2022-01-01108
2021: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01104
Total number of active participants reported on line 7a of the Form 55002021-01-01108
Number of retired or separated participants receiving benefits2021-01-013
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01111
2020: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0197
Total number of active participants reported on line 7a of the Form 55002020-01-01104
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 participants2020-01-01104
2019: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0194
Total number of active participants reported on line 7a of the Form 55002019-01-0194
Number of retired or separated participants receiving benefits2019-01-013
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-0197
2018: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0195
Total number of active participants reported on line 7a of the Form 55002018-01-0194
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 participants2018-01-0194
2017: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0185
Total number of active participants reported on line 7a of the Form 55002017-01-0195
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 participants2017-01-0195

Financial Data on ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN

Measure Date Value
2023 : ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2023 401k financial data
Total plan liabilities at end of year2023-12-31$95,654
Total plan liabilities at beginning of year2023-12-31$91,734
Total income from all sources2023-12-31$1,919,165
Expenses. Total of all expenses incurred2023-12-31$1,887,487
Benefits paid (including direct rollovers)2023-12-31$834,985
Total plan assets at end of year2023-12-31$560,379
Total plan assets at beginning of year2023-12-31$524,781
Value of fidelity bond covering the plan2023-12-31$1,000,000
Total contributions received or receivable from participants2023-12-31$310,094
Expenses. Other expenses not covered elsewhere2023-12-31$689,050
Contributions received from other sources (not participants or employers)2023-12-31$1,787
Other income received2023-12-31$12,416
Net income (gross income less expenses)2023-12-31$31,678
Net plan assets at end of year (total assets less liabilities)2023-12-31$464,725
Net plan assets at beginning of year (total assets less liabilities)2023-12-31$433,047
Total contributions received or receivable from employer(s)2023-12-31$1,594,868
Value of corrective distributions2023-12-31$318,058
Expenses. Administrative service providers (salaries,fees and commissions)2023-12-31$45,394
2022 : ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$91,734
Total plan liabilities at beginning of year2022-12-31$89,687
Total income from all sources2022-12-31$1,831,310
Expenses. Total of all expenses incurred2022-12-31$1,540,304
Benefits paid (including direct rollovers)2022-12-31$810,184
Total plan assets at end of year2022-12-31$524,781
Total plan assets at beginning of year2022-12-31$231,728
Value of fidelity bond covering the plan2022-12-31$1,000,000
Total contributions received or receivable from participants2022-12-31$306,006
Expenses. Other expenses not covered elsewhere2022-12-31$623,881
Contributions received from other sources (not participants or employers)2022-12-31$0
Other income received2022-12-31$1,214
Net income (gross income less expenses)2022-12-31$291,006
Net plan assets at end of year (total assets less liabilities)2022-12-31$433,047
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$142,041
Total contributions received or receivable from employer(s)2022-12-31$1,524,090
Value of corrective distributions2022-12-31$55,087
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$51,152
2021 : ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$89,687
Total plan liabilities at beginning of year2021-12-31$59,753
Total income from all sources2021-12-31$1,531,020
Expenses. Total of all expenses incurred2021-12-31$1,708,597
Benefits paid (including direct rollovers)2021-12-31$980,908
Total plan assets at end of year2021-12-31$231,728
Total plan assets at beginning of year2021-12-31$379,371
Value of fidelity bond covering the plan2021-12-31$1,000,000
Total contributions received or receivable from participants2021-12-31$278,298
Expenses. Other expenses not covered elsewhere2021-12-31$609,230
Other income received2021-12-31$736
Net income (gross income less expenses)2021-12-31$-177,577
Net plan assets at end of year (total assets less liabilities)2021-12-31$142,041
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$319,618
Total contributions received or receivable from employer(s)2021-12-31$1,251,986
Value of corrective distributions2021-12-31$111,516
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$6,943
2020 : ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$59,753
Total plan liabilities at beginning of year2020-12-31$76,735
Total income from all sources2020-12-31$1,511,147
Expenses. Total of all expenses incurred2020-12-31$1,418,045
Benefits paid (including direct rollovers)2020-12-31$652,821
Total plan assets at end of year2020-12-31$379,371
Total plan assets at beginning of year2020-12-31$303,251
Value of fidelity bond covering the plan2020-12-31$1,000,000
Total contributions received or receivable from participants2020-12-31$285,123
Expenses. Other expenses not covered elsewhere2020-12-31$547,801
Contributions received from other sources (not participants or employers)2020-12-31$1,355
Other income received2020-12-31$986
Net income (gross income less expenses)2020-12-31$93,102
Net plan assets at end of year (total assets less liabilities)2020-12-31$319,618
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$226,516
Total contributions received or receivable from employer(s)2020-12-31$1,223,683
Value of corrective distributions2020-12-31$170,987
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$46,436
2019 : ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$76,735
Total plan liabilities at beginning of year2019-12-31$84,199
Total income from all sources2019-12-31$1,391,876
Expenses. Total of all expenses incurred2019-12-31$1,263,272
Benefits paid (including direct rollovers)2019-12-31$660,600
Total plan assets at end of year2019-12-31$303,251
Total plan assets at beginning of year2019-12-31$182,111
Value of fidelity bond covering the plan2019-12-31$1,000,000
Total contributions received or receivable from participants2019-12-31$263,190
Expenses. Other expenses not covered elsewhere2019-12-31$474,702
Contributions received from other sources (not participants or employers)2019-12-31$5,671
Other income received2019-12-31$765
Net income (gross income less expenses)2019-12-31$128,604
Net plan assets at end of year (total assets less liabilities)2019-12-31$226,516
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$97,912
Total contributions received or receivable from employer(s)2019-12-31$1,122,250
Value of corrective distributions2019-12-31$82,212
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$45,758
2018 : ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$84,199
Total plan liabilities at beginning of year2018-12-31$84,123
Total income from all sources2018-12-31$1,221,752
Expenses. Total of all expenses incurred2018-12-31$1,082,358
Benefits paid (including direct rollovers)2018-12-31$652,956
Total plan assets at end of year2018-12-31$182,111
Total plan assets at beginning of year2018-12-31$42,641
Value of fidelity bond covering the plan2018-12-31$1,000,000
Total contributions received or receivable from participants2018-12-31$245,323
Expenses. Other expenses not covered elsewhere2018-12-31$387,360
Other income received2018-12-31$360
Net income (gross income less expenses)2018-12-31$139,394
Net plan assets at end of year (total assets less liabilities)2018-12-31$97,912
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$-41,482
Total contributions received or receivable from employer(s)2018-12-31$976,069
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$42,042
2017 : ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$84,123
Total plan liabilities at beginning of year2017-12-31$0
Total income from all sources2017-12-31$1,035,019
Expenses. Total of all expenses incurred2017-12-31$1,076,501
Benefits paid (including direct rollovers)2017-12-31$684,251
Total plan assets at end of year2017-12-31$42,641
Total plan assets at beginning of year2017-12-31$0
Value of fidelity bond covering the plan2017-12-31$1,000,000
Total contributions received or receivable from participants2017-12-31$220,055
Expenses. Other expenses not covered elsewhere2017-12-31$339,050
Other income received2017-12-31$65
Net income (gross income less expenses)2017-12-31$-41,482
Net plan assets at end of year (total assets less liabilities)2017-12-31$-41,482
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$0
Total contributions received or receivable from employer(s)2017-12-31$814,899
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$53,200

Form 5500 Responses for ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN

2023: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – TrustYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement - TrustYes
2022: ENGLE-HAMBRIGHT & DAVIES, INC. 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: ENGLE-HAMBRIGHT & DAVIES, INC. 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: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL 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: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL 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: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL 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: ENGLE-HAMBRIGHT & DAVIES, INC. GROUP MEDICAL PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
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

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407398
Policy instance 1
Insurance contract or identification number407398
Number of Individuals Covered119
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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 $605,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407398
Policy instance 1
Insurance contract or identification number407398
Number of Individuals Covered108
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 $541,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407398
Policy instance 1
Insurance contract or identification number407398
Number of Individuals Covered111
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 $529,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered0
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 $286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407398
Policy instance 2
Insurance contract or identification number407398
Number of Individuals Covered104
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 $477,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered97
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 $407,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered94
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 $324,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered95
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 $277,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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