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KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN 401k Plan overview

Plan NameKEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN
Plan identification number 503

KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover

401k Sponsoring company profile

KEYSTONE SENIOR MANAGEMENT SERVICES, INC has sponsored the creation of one or more 401k plans.

Company Name:KEYSTONE SENIOR MANAGEMENT SERVICES, INC
Employer identification number (EIN):300036455
NAIC Classification:531310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032019-07-01
5032018-07-01
5032017-07-01DAVE KINGEN
5032016-07-01DAVE KINGEN

Plan Statistics for KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN

401k plan membership statisitcs for KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN

Measure Date Value
2019: KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01162
Total number of active participants reported on line 7a of the Form 55002019-07-01112
Total of all active and inactive participants2019-07-01112
2018: KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01353
Total number of active participants reported on line 7a of the Form 55002018-07-01162
Total of all active and inactive participants2018-07-01162
2017: KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01354
Total number of active participants reported on line 7a of the Form 55002017-07-01353
Total of all active and inactive participants2017-07-01353
2016: KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01162
Total number of active participants reported on line 7a of the Form 55002016-07-01354
Total of all active and inactive participants2016-07-01354

Form 5500 Responses for KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN

2019: KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: KEYSTONE SENIOR MANAGEMENT SERVICES, INC. LIFE AND DISABILITY INSURANCE PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01First time form 5500 has been submittedYes
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number38-1082080
Policy instance 1
Insurance contract or identification number38-1082080
Number of Individuals Covered112
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $21,350
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,350
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number38-1082080
Policy instance 1
Insurance contract or identification number38-1082080
Number of Individuals Covered162
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $24,135
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $132,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,135
Insurance broker organization code?3
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5455778
Policy instance 1
Insurance contract or identification number5455778
Number of Individuals Covered272
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $4,130
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,490
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5455778
Policy instance 2
Insurance contract or identification number5455778
Number of Individuals Covered81
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $3,081
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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