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MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameMARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN
Plan identification number 501

MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

MARTIN STONE QUARRIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:MARTIN STONE QUARRIES, INC.
Employer identification number (EIN):231725744
NAIC Classification:327900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01CHRISTINA M. DAVIS
5012016-01-01STEPHEN BLIVEN
5012015-01-01ANNE KELHART
5012014-10-01ANNE KELHART

Plan Statistics for MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2023: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-0144
Total number of active participants reported on line 7a of the Form 55002023-01-0147
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 participants2023-01-0147
2022: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0145
Total number of active participants reported on line 7a of the Form 55002022-01-0142
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 participants2022-01-0144
2021: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0143
Total number of active participants reported on line 7a of the Form 55002021-01-0144
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 participants2021-01-0145
2020: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0143
Total number of active participants reported on line 7a of the Form 55002020-01-0143
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 participants2020-01-0143
2019: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0142
Total number of active participants reported on line 7a of the Form 55002019-01-0143
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 participants2019-01-0143
2018: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0142
Total number of active participants reported on line 7a of the Form 55002018-01-0142
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 participants2018-01-0142
2017: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0146
Total number of active participants reported on line 7a of the Form 55002017-01-0142
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 participants2017-01-0142
2016: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0141
Total number of active participants reported on line 7a of the Form 55002016-01-0145
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 participants2016-01-0146
2015: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0136
Total number of active participants reported on line 7a of the Form 55002015-01-0141
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0141
2014: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-0142
Total number of active participants reported on line 7a of the Form 55002014-10-0136
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-0136

Financial Data on MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2023 : MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2023 401k financial data
Total plan liabilities at end of year2023-12-31$138,568
Total plan liabilities at beginning of year2023-12-31$307,011
Total income from all sources2023-12-31$1,175,266
Expenses. Total of all expenses incurred2023-12-31$1,087,845
Benefits paid (including direct rollovers)2023-12-31$546,219
Total plan assets at end of year2023-12-31$464,969
Total plan assets at beginning of year2023-12-31$545,991
Value of fidelity bond covering the plan2023-12-31$500,000
Total contributions received or receivable from participants2023-12-31$168,759
Expenses. Other expenses not covered elsewhere2023-12-31$449,839
Contributions received from other sources (not participants or employers)2023-12-31$0
Other income received2023-12-31$7,363
Net income (gross income less expenses)2023-12-31$87,421
Net plan assets at end of year (total assets less liabilities)2023-12-31$326,401
Net plan assets at beginning of year (total assets less liabilities)2023-12-31$238,980
Total contributions received or receivable from employer(s)2023-12-31$999,144
Value of corrective distributions2023-12-31$69,679
Expenses. Administrative service providers (salaries,fees and commissions)2023-12-31$22,108
2022 : MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$307,011
Total plan liabilities at beginning of year2022-12-31$299,872
Total income from all sources2022-12-31$1,097,517
Expenses. Total of all expenses incurred2022-12-31$867,940
Benefits paid (including direct rollovers)2022-12-31$406,847
Total plan assets at end of year2022-12-31$545,991
Total plan assets at beginning of year2022-12-31$309,275
Value of fidelity bond covering the plan2022-12-31$500,000
Total contributions received or receivable from participants2022-12-31$277,909
Expenses. Other expenses not covered elsewhere2022-12-31$411,074
Contributions received from other sources (not participants or employers)2022-12-31$0
Other income received2022-12-31$0
Net income (gross income less expenses)2022-12-31$229,577
Net plan assets at end of year (total assets less liabilities)2022-12-31$238,980
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$9,403
Total contributions received or receivable from employer(s)2022-12-31$819,608
Value of corrective distributions2022-12-31$28,000
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$22,019
2021 : MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$299,872
Total plan liabilities at beginning of year2021-12-31$134,701
Total income from all sources2021-12-31$1,064,514
Expenses. Total of all expenses incurred2021-12-31$1,095,569
Benefits paid (including direct rollovers)2021-12-31$705,667
Total plan assets at end of year2021-12-31$309,275
Total plan assets at beginning of year2021-12-31$175,159
Value of fidelity bond covering the plan2021-12-31$500,000
Total contributions received or receivable from participants2021-12-31$276,989
Expenses. Other expenses not covered elsewhere2021-12-31$372,410
Contributions received from other sources (not participants or employers)2021-12-31$952
Net income (gross income less expenses)2021-12-31$-31,055
Net plan assets at end of year (total assets less liabilities)2021-12-31$9,403
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$40,458
Total contributions received or receivable from employer(s)2021-12-31$786,573
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$17,492
2020 : MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$134,701
Total plan liabilities at beginning of year2020-12-31$106,347
Total income from all sources2020-12-31$1,076,249
Expenses. Total of all expenses incurred2020-12-31$1,077,052
Benefits paid (including direct rollovers)2020-12-31$700,197
Total plan assets at end of year2020-12-31$175,159
Total plan assets at beginning of year2020-12-31$147,608
Value of fidelity bond covering the plan2020-12-31$500,000
Total contributions received or receivable from participants2020-12-31$230,111
Expenses. Other expenses not covered elsewhere2020-12-31$355,695
Net income (gross income less expenses)2020-12-31$-803
Net plan assets at end of year (total assets less liabilities)2020-12-31$40,458
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$41,261
Total contributions received or receivable from employer(s)2020-12-31$846,138
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$21,160
2019 : MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$106,347
Total plan liabilities at beginning of year2019-12-31$81,985
Total income from all sources2019-12-31$925,886
Expenses. Total of all expenses incurred2019-12-31$873,550
Benefits paid (including direct rollovers)2019-12-31$551,707
Total plan assets at end of year2019-12-31$147,608
Total plan assets at beginning of year2019-12-31$70,910
Value of fidelity bond covering the plan2019-12-31$400,000
Total contributions received or receivable from participants2019-12-31$246,023
Expenses. Other expenses not covered elsewhere2019-12-31$301,814
Net income (gross income less expenses)2019-12-31$52,336
Net plan assets at end of year (total assets less liabilities)2019-12-31$41,261
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$-11,075
Total contributions received or receivable from employer(s)2019-12-31$679,863
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$20,029
2018 : MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$81,985
Total plan liabilities at beginning of year2018-12-31$86,739
Total income from all sources2018-12-31$781,608
Expenses. Total of all expenses incurred2018-12-31$764,716
Benefits paid (including direct rollovers)2018-12-31$475,013
Total plan assets at end of year2018-12-31$70,910
Total plan assets at beginning of year2018-12-31$58,772
Value of fidelity bond covering the plan2018-12-31$400,000
Expenses. Other expenses not covered elsewhere2018-12-31$270,024
Net income (gross income less expenses)2018-12-31$16,892
Net plan assets at end of year (total assets less liabilities)2018-12-31$-11,075
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$-27,967
Total contributions received or receivable from employer(s)2018-12-31$781,608
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$19,679
2017 : MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$86,739
Total plan liabilities at beginning of year2017-12-31$132,208
Total income from all sources2017-12-31$706,404
Expenses. Total of all expenses incurred2017-12-31$604,147
Benefits paid (including direct rollovers)2017-12-31$348,275
Total plan assets at end of year2017-12-31$58,772
Total plan assets at beginning of year2017-12-31$1,984
Value of fidelity bond covering the plan2017-12-31$400,000
Total contributions received or receivable from participants2017-12-31$197,680
Expenses. Other expenses not covered elsewhere2017-12-31$235,632
Contributions received from other sources (not participants or employers)2017-12-31$7,323
Net income (gross income less expenses)2017-12-31$102,257
Net plan assets at end of year (total assets less liabilities)2017-12-31$-27,967
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$-130,224
Total contributions received or receivable from employer(s)2017-12-31$501,401
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$20,240
2016 : MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$132,208
Total plan liabilities at beginning of year2016-12-31$36,169
Total income from all sources2016-12-31$590,785
Expenses. Total of all expenses incurred2016-12-31$726,472
Benefits paid (including direct rollovers)2016-12-31$493,446
Total plan assets at end of year2016-12-31$1,984
Total plan assets at beginning of year2016-12-31$41,632
Value of fidelity bond covering the plan2016-12-31$400,000
Total contributions received or receivable from participants2016-12-31$176,308
Expenses. Other expenses not covered elsewhere2016-12-31$211,426
Contributions received from other sources (not participants or employers)2016-12-31$3,066
Other income received2016-12-31$26
Net income (gross income less expenses)2016-12-31$-135,687
Net plan assets at end of year (total assets less liabilities)2016-12-31$-130,224
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$5,463
Total contributions received or receivable from employer(s)2016-12-31$411,385
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$21,600
2015 : MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$36,169
Total plan liabilities at beginning of year2015-12-31$8,345
Total income from all sources2015-12-31$485,685
Expenses. Total of all expenses incurred2015-12-31$472,769
Benefits paid (including direct rollovers)2015-12-31$276,220
Total plan assets at end of year2015-12-31$41,632
Total plan assets at beginning of year2015-12-31$892
Value of fidelity bond covering the plan2015-12-31$400,000
Total contributions received or receivable from participants2015-12-31$145,679
Expenses. Other expenses not covered elsewhere2015-12-31$171,774
Other income received2015-12-31$89
Net income (gross income less expenses)2015-12-31$12,916
Net plan assets at end of year (total assets less liabilities)2015-12-31$5,463
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$-7,453
Total contributions received or receivable from employer(s)2015-12-31$339,917
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$24,775
2014 : MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2014 401k financial data
Total plan liabilities at end of year2014-12-31$8,345
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$119,230
Expenses. Total of all expenses incurred2014-12-31$126,683
Benefits paid (including direct rollovers)2014-12-31$79,208
Total plan assets at end of year2014-12-31$892
Total plan assets at beginning of year2014-12-31$0
Value of fidelity bond covering the plan2014-12-31$400,000
Total contributions received or receivable from participants2014-12-31$33,863
Expenses. Other expenses not covered elsewhere2014-12-31$47,475
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$4
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$-7,453
Net plan assets at end of year (total assets less liabilities)2014-12-31$-7,453
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$0
Total contributions received or receivable from employer(s)2014-12-31$85,363
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$0

Form 5500 Responses for MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN

2023: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT 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: MARTIN STONE QUARRIES, INC. 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: MARTIN STONE QUARRIES, INC. 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: MARTIN STONE QUARRIES, INC. 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: MARTIN STONE QUARRIES, INC. 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: MARTIN STONE QUARRIES, INC. 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: MARTIN STONE QUARRIES, INC. 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: MARTIN STONE QUARRIES, INC. 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: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: MARTIN STONE QUARRIES, INC. EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01First time form 5500 has been submittedYes
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – TrustYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement - TrustYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 3086 )
Policy contract numberUNI-203487
Policy instance 1
Insurance contract or identification numberUNI-203487
Number of Individuals Covered47
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 $414,849
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 number30500023
Policy instance 1
Insurance contract or identification number30500023
Number of Individuals Covered44
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 $376,409
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 number30500023
Policy instance 1
Insurance contract or identification number30500023
Number of Individuals Covered45
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 $336,806
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 number30500023
Policy instance 1
Insurance contract or identification number30500023
Number of Individuals Covered43
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 $321,525
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 Covered43
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 $268,714
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 Covered42
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 $237,804
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 Covered42
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 $201,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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