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EVERSON TESLA, INC. GROUP MEDICAL PLAN 401k Plan overview

Plan NameEVERSON TESLA, INC. GROUP MEDICAL PLAN
Plan identification number 501

EVERSON TESLA, INC. GROUP MEDICAL PLAN Benefits

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

401k Sponsoring company profile

EVERSON TESLA, INC. has sponsored the creation of one or more 401k plans.

Company Name:EVERSON TESLA, INC.
Employer identification number (EIN):510468658
NAIC Classification:335900

Additional information about EVERSON TESLA, INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 3658271

More information about EVERSON TESLA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EVERSON TESLA, INC. GROUP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-10-01
5012022-10-01

Plan Statistics for EVERSON TESLA, INC. GROUP MEDICAL PLAN

401k plan membership statisitcs for EVERSON TESLA, INC. GROUP MEDICAL PLAN

Measure Date Value
2023: EVERSON TESLA, INC. GROUP MEDICAL PLAN 2023 401k membership
Total participants, beginning-of-year2023-10-0178
Total number of active participants reported on line 7a of the Form 55002023-10-0179
Number of retired or separated participants receiving benefits2023-10-011
Number of other retired or separated participants entitled to future benefits2023-10-010
Total of all active and inactive participants2023-10-0180
2022: EVERSON TESLA, INC. GROUP MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-10-0181
Total number of active participants reported on line 7a of the Form 55002022-10-0177
Number of retired or separated participants receiving benefits2022-10-011
Number of other retired or separated participants entitled to future benefits2022-10-010
Total of all active and inactive participants2022-10-0178

Financial Data on EVERSON TESLA, INC. GROUP MEDICAL PLAN

Measure Date Value
2023 : EVERSON TESLA, INC. GROUP MEDICAL PLAN 2023 401k financial data
Total plan liabilities at end of year2023-12-31$107,463
Total plan liabilities at beginning of year2023-12-31$93,639
Total income from all sources2023-12-31$401,334
Expenses. Total of all expenses incurred2023-12-31$415,059
Benefits paid (including direct rollovers)2023-12-31$250,959
Total plan assets at end of year2023-12-31$38,151
Total plan assets at beginning of year2023-12-31$38,052
Value of fidelity bond covering the plan2023-12-31$1,000,000
Total contributions received or receivable from participants2023-12-31$42,849
Expenses. Other expenses not covered elsewhere2023-12-31$162,678
Contributions received from other sources (not participants or employers)2023-12-31$211
Other income received2023-12-31$264
Net income (gross income less expenses)2023-12-31$-13,725
Net plan assets at end of year (total assets less liabilities)2023-12-31$-69,312
Net plan assets at beginning of year (total assets less liabilities)2023-12-31$-55,587
Total contributions received or receivable from employer(s)2023-12-31$358,010
Value of corrective distributions2023-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2023-12-31$1,422
Total plan liabilities at end of year2023-09-30$93,639
Total plan liabilities at beginning of year2023-09-30$0
Total income from all sources2023-09-30$1,567,579
Expenses. Total of all expenses incurred2023-09-30$1,623,166
Benefits paid (including direct rollovers)2023-09-30$975,523
Total plan assets at end of year2023-09-30$38,052
Total plan assets at beginning of year2023-09-30$0
Value of fidelity bond covering the plan2023-09-30$1,000,000
Total contributions received or receivable from participants2023-09-30$184,097
Expenses. Other expenses not covered elsewhere2023-09-30$641,949
Contributions received from other sources (not participants or employers)2023-09-30$2,896
Other income received2023-09-30$560
Net income (gross income less expenses)2023-09-30$-55,587
Net plan assets at end of year (total assets less liabilities)2023-09-30$-55,587
Net plan assets at beginning of year (total assets less liabilities)2023-09-30$0
Total contributions received or receivable from employer(s)2023-09-30$1,380,026
Value of corrective distributions2023-09-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2023-09-30$5,694

Form 5500 Responses for EVERSON TESLA, INC. GROUP MEDICAL PLAN

2023: EVERSON TESLA, INC. GROUP MEDICAL PLAN 2023 form 5500 responses
2023-10-01Type of plan entitySingle employer plan
2023-10-01Submission has been amendedNo
2023-10-01This submission is the final filingNo
2023-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2023-10-01Plan is a collectively bargained planNo
2023-10-01Plan funding arrangement – InsuranceYes
2023-10-01Plan funding arrangement – TrustYes
2023-10-01Plan funding arrangement – General assets of the sponsorYes
2023-10-01Plan benefit arrangement – InsuranceYes
2023-10-01Plan benefit arrangement - TrustYes
2023-10-01Plan benefit arrangement – General assets of the sponsorYes
2022: EVERSON TESLA, INC. GROUP MEDICAL PLAN 2022 form 5500 responses
2022-10-01Type of plan entitySingle employer plan
2022-10-01First time form 5500 has been submittedYes
2022-10-01Submission has been amendedNo
2022-10-01This submission is the final filingNo
2022-10-01This return/report is a short plan year return/report (less than 12 months)No
2022-10-01Plan is a collectively bargained planNo
2022-10-01Plan funding arrangement – InsuranceYes
2022-10-01Plan funding arrangement – TrustYes
2022-10-01Plan funding arrangement – General assets of the sponsorYes
2022-10-01Plan benefit arrangement – InsuranceYes
2022-10-01Plan benefit arrangement - TrustYes
2022-10-01Plan 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-203277
Policy instance 1
Insurance contract or identification numberUNI-203277
Number of Individuals Covered79
Insurance policy start date2023-10-01
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 $147,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 3086 )
Policy contract number000000
Policy instance 1
Insurance contract or identification number000000
Number of Individuals Covered78
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $573,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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