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EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan NameEXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number 510

EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

EXCALIBUR YOUTH SERVICE, LLC has sponsored the creation of one or more 401k plans.

Company Name:EXCALIBUR YOUTH SERVICE, LLC
Employer identification number (EIN):571105666
NAIC Classification:561210
NAIC Description:Facilities Support Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5102021-01-01
5102021-01-01MARVIN J SHORT III
5102020-01-01
5102019-01-01
5102018-01-01
5102017-01-01MARVIN J. SHORT III
5102016-01-01MARVIN J. SHORT III
5102015-01-01MARVIN J. SHORT III
5102014-01-01MARVIN J. SHORT III
5102013-01-01MARVIN J. SHORT III
5102012-01-01MARVIN J. SHORT III
5102011-01-01MARVIN J. SHORT III
5102009-01-01MARVIN J. SHORT III

Plan Statistics for EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN

401k plan membership statisitcs for EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN

Measure Date Value
2021: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01287
Total of all active and inactive participants2021-01-010
Total participants2021-01-010
2020: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01265
Total number of active participants reported on line 7a of the Form 55002020-01-01287
Total of all active and inactive participants2020-01-01287
Total participants2020-01-01287
2019: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01261
Total number of active participants reported on line 7a of the Form 55002019-01-01265
Total of all active and inactive participants2019-01-01265
Total participants2019-01-01265
2018: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01233
Total number of active participants reported on line 7a of the Form 55002018-01-01261
Total of all active and inactive participants2018-01-01261
Total participants2018-01-01261
2017: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01288
Total number of active participants reported on line 7a of the Form 55002017-01-01233
Number of retired or separated participants receiving benefits2017-01-01233
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01466
2016: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01273
Total number of active participants reported on line 7a of the Form 55002016-01-01288
Number of retired or separated participants receiving benefits2016-01-01288
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01576
2015: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01246
Total number of active participants reported on line 7a of the Form 55002015-01-01273
Number of retired or separated participants receiving benefits2015-01-01273
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01546
2014: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01199
Total number of active participants reported on line 7a of the Form 55002014-01-01246
Number of retired or separated participants receiving benefits2014-01-01246
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01492
2013: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01339
Total number of active participants reported on line 7a of the Form 55002013-01-01199
Total of all active and inactive participants2013-01-01199
2012: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01485
Total number of active participants reported on line 7a of the Form 55002012-01-01339
Total of all active and inactive participants2012-01-01339
2011: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01172
Total number of active participants reported on line 7a of the Form 55002011-01-01485
Total of all active and inactive participants2011-01-01485
2009: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01125
Total number of active participants reported on line 7a of the Form 55002009-01-01171
Total of all active and inactive participants2009-01-01171

Form 5500 Responses for EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN

2021: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01This submission is the final filingYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: EXCALIBUR YOUTH SERVICES LLC EMPLOYEE WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01First time form 5500 has been submittedYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan 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 number944963
Policy instance 1
BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )
Policy contract number00254
Policy instance 1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number936718
Policy instance 2
PHYSICIANS EYECARE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number00505
Policy instance 4
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00555180
Policy instance 3
BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )
Policy contract number00254
Policy instance 1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number00555180
Policy instance 2
BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )
Policy contract number03-07656
Policy instance 2
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number00555180
Policy instance 3
BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )
Policy contract number00254
Policy instance 1
BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )
Policy contract number00254
Policy instance 1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number234046
Policy instance 3
BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )
Policy contract number03-07656
Policy instance 2
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number234046
Policy instance 2
BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )
Policy contract numberBA477
Policy instance 1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number234046
Policy instance 2
BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )
Policy contract numberBA477
Policy instance 1
BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )
Policy contract numberBA477
Policy instance 1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number234046
Policy instance 2
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00443210
Policy instance 2
BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )
Policy contract numberBA477
Policy instance 1
BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )
Policy contract numberBA477
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00443210
Policy instance 2
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0007003978
Policy instance 3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0007003978
Policy instance 5
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number095604
Policy instance 4
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number115968
Policy instance 1
BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )
Policy contract numberBA477
Policy instance 2
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00443210
Policy instance 3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number095604
Policy instance 4
BLUECHOICE HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 95741 )
Policy contract numberBA477
Policy instance 2
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number115968
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00443210
Policy instance 3

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