401k Plan data: KEYSTONE WELFARE BENEFIT PLAN plan

KEYSTONE WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	KEYSTONE WELFARE BENEFIT PLAN
Plan identification number	501

KEYSTONE WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

KEYSTONE ENERGY & POWER CORP has sponsored the creation of one or more 401k plans.

Company Name: KEYSTONE ENERGY & POWER CORP

Employer identification number (EIN): 271383247

NAIC Classification: 238210
NAIC Description: Electrical Contractors and Other Wiring Installation Contractors

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KEYSTONE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-10-01 SHARON WILLIAMS 2024-12-13
501 2022-10-01 SHARON WILLIAMS 2024-04-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-10-01	SHARON WILLIAMS	2024-12-13
501	2022-10-01	SHARON WILLIAMS	2024-04-12

Form 5500 Responses for KEYSTONE WELFARE BENEFIT PLAN

2023: KEYSTONE WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-10-01	Type of plan entity	Single employer plan
2023-10-01	Plan funding arrangement – Insurance	Yes
2023-10-01	Plan benefit arrangement – Insurance	Yes
2022: KEYSTONE WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	First time form 5500 has been submitted	Yes
2022-10-01	Plan funding arrangement – Insurance	Yes
2022-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

J4848

Policy instance

Insurance contract or identification number	J4848
Number of Individuals Covered	12
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Total amount of commissions paid to insurance broker	USD $10,394
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

583677

Policy instance

Insurance contract or identification number	583677
Number of Individuals Covered	149
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Total amount of commissions paid to insurance broker	USD $3,166
Total amount of fees paid to insurance company	USD $1,570
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $38,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

J4848

Policy instance

Insurance contract or identification number	J4848
Number of Individuals Covered	49
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Total amount of commissions paid to insurance broker	USD $20,987
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E5716543

Policy instance

Insurance contract or identification number	E5716543
Number of Individuals Covered	77
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Total amount of commissions paid to insurance broker	USD $20,857
Total amount of fees paid to insurance company	USD $6,927
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $81,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

J4848

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

583677

Policy instance

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

J4848

Policy instance

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E5716543

Policy instance

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Company Name:	KEYSTONE ENERGY & POWER CORP
Employer identification number (EIN):	271383247
NAIC Classification:	238210
NAIC Description:	Electrical Contractors and Other Wiring Installation Contractors