2023 Form 5500 filing — Keystone Independence Management Group Medical Plan (501)
Plain-English filing summary
According to public Form 5500 filings published through the U.S. Department of Labor (DOL) Employee Benefits Security Administration (EBSA) via the EFAST2 system, this is the 2023 Form 5500 filing (EFAST2 acknowledgement 20240923075052NAL0022959810001) for Keystone Independence Management Group Medical Plan (501), reported by Keystone Independence Management under EIN 25-1876726 and plan number 501. It reports 33 participants. Attached schedules in the loaded dataset include Schedule I (small plan financials), Schedule C (service provider compensation).
- EFAST2 acknowledgement
- 20240923075052NAL0022959810001
- Filing year
- 2023
- Form type
- 2
- Plan sponsor
- Keystone Independence Management
- EIN
- 25-1876726
- Plan number
- 501
- Location
- Hermitage, PA
- Participants
- 33
- Schedules available
- Schedule I, Schedule C
- Received date
- not reported in the loaded dataset
Reported financial snapshot (2023)
- Total assets (EOY)
- $2,701
- Total liabilities (EOY)
- $373,319
- Net assets (EOY)
- -$370,618
- Employer contributions
- $465,623
- Participant contributions
- $50,498
- Total income / additions
- $516,436
- Benefits paid
- $339,528
- Administrative expenses
- $3,872
- Total expenses
- $527,402
- Net increase / (decrease)
- -$10,966
- Schedule source
- Schedule I
Reported service provider compensation (Schedule C)
| Provider | Service | Direct comp. | Indirect comp. |
|---|---|---|---|
| The Benecon Group, LLC | BROKER | $9,459 | not reported in the loaded dataset |
| The Djb Group | BROKER | $9,175 | not reported in the loaded dataset |
| First National Insurance Agency | BROKER | $4,000 | not reported in the loaded dataset |
| Meritain Health, An Aetna Company | ADMIN | $3,872 | not reported in the loaded dataset |
| Connectcare3 LLC | PATIENT ADVOCATE | $2,004 | not reported in the loaded dataset |