2023 Form 5500 filing — Club Retiree Medical And Dental Plan
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 20241010123614NAL0034035488001) for Club Retiree Medical And Dental Plan, reported by Automobile Club Of So California under EIN 95-0514585 and plan number 516. It reports 2,496 participants. Attached schedules in the loaded dataset include Schedule H (large plan financials), Schedule C (service provider compensation).
- EFAST2 acknowledgement
- 20241010123614NAL0034035488001
- Filing year
- 2023
- Form type
- 2
- Plan sponsor
- Automobile Club Of So California
- EIN
- 95-0514585
- Plan number
- 516
- Location
- Costa Mesa, CA
- Participants
- 2,496
- Schedules available
- Schedule H, Schedule C
- Received date
- not reported in the loaded dataset
Reported financial snapshot (2023)
- Total assets (EOY)
- $53,039,276
- Total liabilities (EOY)
- $0
- Net assets (EOY)
- $53,039,276
- Employer contributions
- $787,912
- Participant contributions
- $1,310,067
- Total income / additions
- $5,733,912
- Benefits paid
- $4,077,611
- Administrative expenses
- $126,106
- Total expenses
- $4,203,717
- Net increase / (decrease)
- $1,530,195
- Schedule source
- Schedule H
Reported service provider compensation (Schedule C)
| Provider | Service | Direct comp. | Indirect comp. |
|---|---|---|---|
| Cvshealth | CONTRACT ADMIN | $1,000,687 | not reported in the loaded dataset |
| Webtpa Employer Services, LLC | CLAIMS PROCESSOR | $60,390 | not reported in the loaded dataset |
| T. Rowe Price Associates, Inc. | INVESTMT MGMT | $56,736 | $0 |
| Alight Holding Company, LLC | PLAN ADMINISTRATOR | $45,048 | not reported in the loaded dataset |
| Wageworks, Inc. | CLAIMS PROCESSOR | $9,464 | not reported in the loaded dataset |
| Jpmorgan Chase Bank, N.A. | TRUSTEE | $7,000 | $2,189 |