KEYSTONE CUSTOM MANAGEMENT, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan KEYSTONE CUSTOM MANAGEMENT, LLC GROUP HEALTH PLAN
| Measure | Date | Value |
|---|
| 2022 : KEYSTONE CUSTOM MANAGEMENT, LLC GROUP HEALTH PLAN 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-12-31 | $191,102 |
| Total plan liabilities at beginning of year | 2022-12-31 | $191,498 |
| Total income from all sources | 2022-12-31 | $131,228 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $132,248 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $95,792 |
| Total plan assets at end of year | 2022-12-31 | $3,108 |
| Total plan assets at beginning of year | 2022-12-31 | $4,524 |
| Value of fidelity bond covering the plan | 2022-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2022-12-31 | $52,106 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $35,860 |
| Contributions received from other sources (not participants or employers) | 2022-12-31 | $0 |
| Other income received | 2022-12-31 | $39 |
| Net income (gross income less expenses) | 2022-12-31 | $-1,020 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $-187,994 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $-186,974 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $79,083 |
| Value of corrective distributions | 2022-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $596 |
| Total plan liabilities at end of year | 2022-11-30 | $191,498 |
| Total plan liabilities at beginning of year | 2022-11-30 | $56,502 |
| Total income from all sources | 2022-11-30 | $1,368,738 |
| Expenses. Total of all expenses incurred | 2022-11-30 | $1,555,712 |
| Benefits paid (including direct rollovers) | 2022-11-30 | $1,155,854 |
| Total plan assets at end of year | 2022-11-30 | $4,524 |
| Total plan assets at beginning of year | 2022-11-30 | $56,502 |
| Value of fidelity bond covering the plan | 2022-11-30 | $500,000 |
| Total contributions received or receivable from participants | 2022-11-30 | $620,408 |
| Expenses. Other expenses not covered elsewhere | 2022-11-30 | $388,238 |
| Contributions received from other sources (not participants or employers) | 2022-11-30 | $0 |
| Other income received | 2022-11-30 | $106 |
| Net income (gross income less expenses) | 2022-11-30 | $-186,974 |
| Net plan assets at end of year (total assets less liabilities) | 2022-11-30 | $-186,974 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-11-30 | $0 |
| Total contributions received or receivable from employer(s) | 2022-11-30 | $748,224 |
| Value of corrective distributions | 2022-11-30 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-11-30 | $11,620 |
| 2021 : KEYSTONE CUSTOM MANAGEMENT, LLC GROUP HEALTH PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-11-30 | $56,502 |
| Total plan liabilities at beginning of year | 2021-11-30 | $25,192 |
| Total income from all sources | 2021-11-30 | $965,483 |
| Expenses. Total of all expenses incurred | 2021-11-30 | $965,483 |
| Benefits paid (including direct rollovers) | 2021-11-30 | $662,036 |
| Total plan assets at end of year | 2021-11-30 | $56,502 |
| Total plan assets at beginning of year | 2021-11-30 | $25,192 |
| Value of fidelity bond covering the plan | 2021-11-30 | $500,000 |
| Total contributions received or receivable from participants | 2021-11-30 | $436,701 |
| Expenses. Other expenses not covered elsewhere | 2021-11-30 | $234,615 |
| Other income received | 2021-11-30 | $6 |
| Net income (gross income less expenses) | 2021-11-30 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2021-11-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-11-30 | $0 |
| Total contributions received or receivable from employer(s) | 2021-11-30 | $528,776 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-11-30 | $68,832 |
| 2020 : KEYSTONE CUSTOM MANAGEMENT, LLC GROUP HEALTH PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-11-30 | $25,192 |
| Total plan liabilities at beginning of year | 2020-11-30 | $5,780 |
| Total income from all sources | 2020-11-30 | $687,642 |
| Expenses. Total of all expenses incurred | 2020-11-30 | $688,871 |
| Benefits paid (including direct rollovers) | 2020-11-30 | $457,789 |
| Total plan assets at end of year | 2020-11-30 | $25,192 |
| Total plan assets at beginning of year | 2020-11-30 | $7,009 |
| Value of fidelity bond covering the plan | 2020-11-30 | $500,000 |
| Total contributions received or receivable from participants | 2020-11-30 | $262,311 |
| Expenses. Other expenses not covered elsewhere | 2020-11-30 | $170,483 |
| Other income received | 2020-11-30 | $44 |
| Net income (gross income less expenses) | 2020-11-30 | $-1,229 |
| Net plan assets at end of year (total assets less liabilities) | 2020-11-30 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-11-30 | $1,229 |
| Total contributions received or receivable from employer(s) | 2020-11-30 | $425,287 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-11-30 | $60,599 |
| 2019 : KEYSTONE CUSTOM MANAGEMENT, LLC GROUP HEALTH PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-11-30 | $5,780 |
| Total income from all sources | 2019-11-30 | $550,709 |
| Expenses. Total of all expenses incurred | 2019-11-30 | $549,480 |
| Benefits paid (including direct rollovers) | 2019-11-30 | $348,316 |
| Total plan assets at end of year | 2019-11-30 | $7,009 |
| Value of fidelity bond covering the plan | 2019-11-30 | $500,000 |
| Total contributions received or receivable from participants | 2019-11-30 | $272,527 |
| Expenses. Other expenses not covered elsewhere | 2019-11-30 | $150,178 |
| Noncash contributions received | 2019-11-30 | $29 |
| Net income (gross income less expenses) | 2019-11-30 | $1,229 |
| Net plan assets at end of year (total assets less liabilities) | 2019-11-30 | $1,229 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-11-30 | $0 |
| Total contributions received or receivable from employer(s) | 2019-11-30 | $278,153 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-11-30 | $50,986 |
| 2023: KEYSTONE CUSTOM MANAGEMENT, LLC GROUP HEALTH PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: KEYSTONE CUSTOM MANAGEMENT, LLC GROUP HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-12-01 | Type of plan entity | Single employer plan |
| 2022-12-01 | Submission has been amended | No |
| 2022-12-01 | This submission is the final filing | No |
| 2022-12-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-12-01 | Plan is a collectively bargained plan | No |
| 2022-12-01 | Plan funding arrangement – Insurance | Yes |
| 2022-12-01 | Plan funding arrangement – Trust | Yes |
| 2022-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-12-01 | Plan benefit arrangement - Trust | Yes |
| 2021: KEYSTONE CUSTOM MANAGEMENT, LLC GROUP HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | Submission has been amended | No |
| 2021-12-01 | This submission is the final filing | No |
| 2021-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-12-01 | Plan is a collectively bargained plan | No |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan funding arrangement – Trust | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement - Trust | Yes |
| 2020: KEYSTONE CUSTOM MANAGEMENT, LLC GROUP HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Submission has been amended | No |
| 2020-12-01 | This submission is the final filing | No |
| 2020-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-12-01 | Plan is a collectively bargained plan | No |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan funding arrangement – Trust | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement - Trust | Yes |
| 2019: KEYSTONE CUSTOM MANAGEMENT, LLC GROUP HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-12-01 | Type of plan entity | Single employer plan |
| 2019-12-01 | Submission has been amended | No |
| 2019-12-01 | This submission is the final filing | No |
| 2019-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-12-01 | Plan is a collectively bargained plan | No |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan funding arrangement – Trust | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement - Trust | Yes |
| 2018: KEYSTONE CUSTOM MANAGEMENT, LLC GROUP HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-12-01 | Type of plan entity | Single employer plan |
| 2018-12-01 | First time form 5500 has been submitted | Yes |
| 2018-12-01 | Submission has been amended | No |
| 2018-12-01 | This submission is the final filing | No |
| 2018-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-12-01 | Plan is a collectively bargained plan | No |
| 2018-12-01 | Plan funding arrangement – Insurance | Yes |
| 2018-12-01 | Plan funding arrangement – Trust | Yes |
| 2018-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-12-01 | Plan benefit arrangement - Trust | Yes |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639943 |
| Policy instance | 4 |
| Insurance contract or identification number | 639943 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639942 |
| Policy instance | 3 |
| Insurance contract or identification number | 639942 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 259943 |
| Policy instance | 2 |
| Insurance contract or identification number | 259943 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $471 | | Total amount of fees paid to insurance company | USD $0 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $4,895 | | 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 number | 30800033 |
| Policy instance | 1 |
| Insurance contract or identification number | 30800033 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-30 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $30,583 | | 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 number | 30800033 |
| Policy instance | 1 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 259943 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639942 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639943 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0633644 |
| Policy instance | 5 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639943 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639942 |
| Policy instance | 3 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 259943 |
| Policy instance | 2 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | GENESIS |
| Policy instance | 1 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | GENESIS |
| Policy instance | 1 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 259943 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639942 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639943 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0633644 |
| Policy instance | 5 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | R0633644 |
| Policy instance | 5 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639942 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 639943 |
| Policy instance | 4 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 259943 |
| Policy instance | 2 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | GENESIS |
| Policy instance | 1 |
