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SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 401k Plan overview

Plan NameSPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN
Plan identification number 501

SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN Benefits

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

401k Sponsoring company profile

SPRING CITY ELECTRICAL MANUFACTURING CO. has sponsored the creation of one or more 401k plans.

Company Name:SPRING CITY ELECTRICAL MANUFACTURING CO.
Employer identification number (EIN):232482511
NAIC Classification:335900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH 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
5012017-01-01THOMAS HARRIS
5012016-12-01THOMAS HARRIS
5012015-12-01THOMAS HARRIS

Plan Statistics for SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN

401k plan membership statisitcs for SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN

Measure Date Value
2023: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-0170
Total number of active participants reported on line 7a of the Form 55002023-01-0177
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 participants2023-01-0177
2022: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0180
Total number of active participants reported on line 7a of the Form 55002022-01-0170
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 participants2022-01-0170
2021: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0188
Total number of active participants reported on line 7a of the Form 55002021-01-0180
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0180
2020: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0185
Total number of active participants reported on line 7a of the Form 55002020-01-0187
Number of retired or separated participants receiving benefits2020-01-011
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-0188
2019: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0171
Total number of active participants reported on line 7a of the Form 55002019-01-0185
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 participants2019-01-0185
2018: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0174
Total number of active participants reported on line 7a of the Form 55002018-01-0171
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 participants2018-01-0171
2017: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0178
Total number of active participants reported on line 7a of the Form 55002017-01-0173
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0174
2016: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-0179
Total number of active participants reported on line 7a of the Form 55002016-12-0178
Number of retired or separated participants receiving benefits2016-12-010
Number of other retired or separated participants entitled to future benefits2016-12-010
Total of all active and inactive participants2016-12-0178
2015: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-0176
Total number of active participants reported on line 7a of the Form 55002015-12-0175
Number of retired or separated participants receiving benefits2015-12-012
Number of other retired or separated participants entitled to future benefits2015-12-010
Total of all active and inactive participants2015-12-0177

Financial Data on SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN

Measure Date Value
2023 : SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2023 401k financial data
Total plan liabilities at end of year2023-12-31$94,019
Total plan liabilities at beginning of year2023-12-31$89,914
Total income from all sources2023-12-31$1,118,688
Expenses. Total of all expenses incurred2023-12-31$843,930
Benefits paid (including direct rollovers)2023-12-31$420,760
Total plan assets at end of year2023-12-31$476,315
Total plan assets at beginning of year2023-12-31$197,452
Value of fidelity bond covering the plan2023-12-31$500,000
Total contributions received or receivable from participants2023-12-31$100
Expenses. Other expenses not covered elsewhere2023-12-31$402,957
Contributions received from other sources (not participants or employers)2023-12-31$100
Other income received2023-12-31$6,901
Net income (gross income less expenses)2023-12-31$274,758
Net plan assets at end of year (total assets less liabilities)2023-12-31$382,296
Net plan assets at beginning of year (total assets less liabilities)2023-12-31$107,538
Total contributions received or receivable from employer(s)2023-12-31$1,111,587
Value of corrective distributions2023-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2023-12-31$20,213
2022 : SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$89,914
Total plan liabilities at beginning of year2022-12-31$42,327
Total income from all sources2022-12-31$1,266,419
Expenses. Total of all expenses incurred2022-12-31$1,487,414
Benefits paid (including direct rollovers)2022-12-31$755,906
Total plan assets at end of year2022-12-31$197,452
Total plan assets at beginning of year2022-12-31$370,860
Value of fidelity bond covering the plan2022-12-31$500,000
Total contributions received or receivable from participants2022-12-31$307,538
Expenses. Other expenses not covered elsewhere2022-12-31$406,085
Contributions received from other sources (not participants or employers)2022-12-31$31,354
Other income received2022-12-31$877
Net income (gross income less expenses)2022-12-31$-220,995
Net plan assets at end of year (total assets less liabilities)2022-12-31$107,538
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$328,533
Total contributions received or receivable from employer(s)2022-12-31$926,650
Value of corrective distributions2022-12-31$281,592
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$43,831
2021 : SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$42,327
Total plan liabilities at beginning of year2021-12-31$67,399
Total income from all sources2021-12-31$1,336,308
Expenses. Total of all expenses incurred2021-12-31$1,459,172
Benefits paid (including direct rollovers)2021-12-31$513,436
Total plan assets at end of year2021-12-31$370,860
Total plan assets at beginning of year2021-12-31$518,796
Value of fidelity bond covering the plan2021-12-31$500,000
Total contributions received or receivable from participants2021-12-31$348,626
Expenses. Other expenses not covered elsewhere2021-12-31$405,262
Contributions received from other sources (not participants or employers)2021-12-31$12,344
Other income received2021-12-31$1,325
Net income (gross income less expenses)2021-12-31$-122,864
Net plan assets at end of year (total assets less liabilities)2021-12-31$328,533
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$451,397
Total contributions received or receivable from employer(s)2021-12-31$974,013
Value of corrective distributions2021-12-31$487,949
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$52,525
2020 : SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$67,399
Total plan liabilities at beginning of year2020-12-31$103,844
Total income from all sources2020-12-31$1,497,781
Expenses. Total of all expenses incurred2020-12-31$1,088,680
Benefits paid (including direct rollovers)2020-12-31$534,928
Total plan assets at end of year2020-12-31$518,796
Total plan assets at beginning of year2020-12-31$146,140
Value of fidelity bond covering the plan2020-12-31$400,000
Total contributions received or receivable from participants2020-12-31$394,999
Expenses. Other expenses not covered elsewhere2020-12-31$429,891
Contributions received from other sources (not participants or employers)2020-12-31$22,933
Other income received2020-12-31$939
Net income (gross income less expenses)2020-12-31$409,101
Net plan assets at end of year (total assets less liabilities)2020-12-31$451,397
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$42,296
Total contributions received or receivable from employer(s)2020-12-31$1,078,910
Value of corrective distributions2020-12-31$67,929
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$55,932
2019 : SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$103,844
Total plan liabilities at beginning of year2019-12-31$187,551
Total income from all sources2019-12-31$1,292,570
Expenses. Total of all expenses incurred2019-12-31$1,180,033
Benefits paid (including direct rollovers)2019-12-31$737,533
Total plan assets at end of year2019-12-31$146,140
Total plan assets at beginning of year2019-12-31$117,310
Value of fidelity bond covering the plan2019-12-31$400,000
Total contributions received or receivable from participants2019-12-31$376,249
Expenses. Other expenses not covered elsewhere2019-12-31$365,229
Contributions received from other sources (not participants or employers)2019-12-31$0
Other income received2019-12-31$326
Net income (gross income less expenses)2019-12-31$112,537
Net plan assets at end of year (total assets less liabilities)2019-12-31$42,296
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$-70,241
Total contributions received or receivable from employer(s)2019-12-31$915,995
Value of corrective distributions2019-12-31$25,618
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$51,653
2018 : SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$187,551
Total plan liabilities at beginning of year2018-12-31$82,171
Total income from all sources2018-12-31$1,176,867
Expenses. Total of all expenses incurred2018-12-31$1,431,128
Benefits paid (including direct rollovers)2018-12-31$835,560
Total plan assets at end of year2018-12-31$117,310
Total plan assets at beginning of year2018-12-31$266,191
Value of fidelity bond covering the plan2018-12-31$400,000
Total contributions received or receivable from participants2018-12-31$329,968
Expenses. Other expenses not covered elsewhere2018-12-31$300,957
Contributions received from other sources (not participants or employers)2018-12-31$0
Other income received2018-12-31$856
Net income (gross income less expenses)2018-12-31$-254,261
Net plan assets at end of year (total assets less liabilities)2018-12-31$-70,241
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$184,020
Total contributions received or receivable from employer(s)2018-12-31$846,043
Value of corrective distributions2018-12-31$251,469
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$43,142
2017 : SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$82,171
Total plan liabilities at beginning of year2017-12-31$93,972
Total income from all sources2017-12-31$1,246,820
Expenses. Total of all expenses incurred2017-12-31$1,080,998
Benefits paid (including direct rollovers)2017-12-31$655,677
Total plan assets at end of year2017-12-31$266,191
Total plan assets at beginning of year2017-12-31$112,170
Value of fidelity bond covering the plan2017-12-31$400,000
Total contributions received or receivable from participants2017-12-31$353,681
Expenses. Other expenses not covered elsewhere2017-12-31$309,033
Contributions received from other sources (not participants or employers)2017-12-31$25,062
Other income received2017-12-31$404
Net income (gross income less expenses)2017-12-31$165,822
Net plan assets at end of year (total assets less liabilities)2017-12-31$184,020
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$18,198
Total contributions received or receivable from employer(s)2017-12-31$867,673
Value of corrective distributions2017-12-31$71,148
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$45,140
2016 : SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$93,972
Total plan liabilities at beginning of year2016-12-31$96,919
Total income from all sources2016-12-31$91,617
Expenses. Total of all expenses incurred2016-12-31$109,569
Benefits paid (including direct rollovers)2016-12-31$82,067
Total plan assets at end of year2016-12-31$112,170
Total plan assets at beginning of year2016-12-31$133,069
Value of fidelity bond covering the plan2016-12-31$400,000
Total contributions received or receivable from participants2016-12-31$22,000
Expenses. Other expenses not covered elsewhere2016-12-31$23,465
Contributions received from other sources (not participants or employers)2016-12-31$1,600
Other income received2016-12-31$25
Net income (gross income less expenses)2016-12-31$-17,952
Net plan assets at end of year (total assets less liabilities)2016-12-31$18,198
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$36,150
Total contributions received or receivable from employer(s)2016-12-31$67,992
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$4,037
Total plan liabilities at end of year2016-11-30$96,919
Total plan liabilities at beginning of year2016-11-30$0
Total income from all sources2016-11-30$1,081,404
Expenses. Total of all expenses incurred2016-11-30$1,045,254
Benefits paid (including direct rollovers)2016-11-30$715,544
Total plan assets at end of year2016-11-30$133,069
Total plan assets at beginning of year2016-11-30$0
Value of fidelity bond covering the plan2016-11-30$400,000
Total contributions received or receivable from participants2016-11-30$294,432
Expenses. Other expenses not covered elsewhere2016-11-30$282,224
Contributions received from other sources (not participants or employers)2016-11-30$7,999
Other income received2016-11-30$65
Net income (gross income less expenses)2016-11-30$36,150
Net plan assets at end of year (total assets less liabilities)2016-11-30$36,150
Net plan assets at beginning of year (total assets less liabilities)2016-11-30$0
Total contributions received or receivable from employer(s)2016-11-30$778,908
Expenses. Administrative service providers (salaries,fees and commissions)2016-11-30$47,486

Form 5500 Responses for SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN

2023: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH 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: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH 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: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH 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 funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH 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 funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH 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: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH 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: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH 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 benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Submission has been amendedNo
2016-12-01This submission is the final filingNo
2016-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-12-01Plan is a collectively bargained planNo
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan benefit arrangement – InsuranceYes
2016-12-01Plan benefit arrangement - TrustYes
2015: SPRING CITY ELECTRICAL MANUFACTURING COOMPANY GROUP HEALTH PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01First time form 5500 has been submittedYes
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)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan benefit arrangement – InsuranceYes
2015-12-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407662
Policy instance 1
Insurance contract or identification number407662
Number of Individuals Covered77
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 $349,280
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 number407662
Policy instance 1
Insurance contract or identification number407662
Number of Individuals Covered70
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 $349,356
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 number30500155
Policy instance 1
Insurance contract or identification number30500155
Number of Individuals Covered0
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 $-906
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 number407662
Policy instance 2
Insurance contract or identification number407662
Number of Individuals Covered80
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 $344,172
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 number30500155
Policy instance 1
Insurance contract or identification number30500155
Number of Individuals Covered87
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 $362,295
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 Covered85
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 $304,023
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 Covered71
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 $245,949
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 Covered73
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 $231,579
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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