2023 Form 5500 filing — Southern Employers Hospitalization, Dental & Vision Care 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 20241015111154NAL0048985904001) for Southern Employers Hospitalization, Dental & Vision Care Plan, reported by Racetrac, Inc. under EIN 63-0642959 and plan number 507. It reports 4,498 participants. Attached schedules in the loaded dataset include Schedule H (large plan financials), Schedule C (service provider compensation).
- EFAST2 acknowledgement
- 20241015111154NAL0048985904001
- Filing year
- 2023
- Form type
- 2
- Plan sponsor
- Racetrac, Inc.
- EIN
- 63-0642959
- Plan number
- 507
- Location
- Atlanta, GA
- Participants
- 4,498
- Schedules available
- Schedule H, Schedule C
- Received date
- not reported in the loaded dataset
Reported financial snapshot (2023)
- Total assets (EOY)
- $0
- Total liabilities (EOY)
- $0
- Net assets (EOY)
- $0
- Participant contributions
- $2,785,699
- Total income / additions
- $2,786,098
- Benefits paid
- $2,018,289
- Administrative expenses
- $298,745
- Total expenses
- $2,317,034
- Net increase / (decrease)
- $469,064
- Schedule source
- Schedule H
Reported service provider compensation (Schedule C)
| Provider | Service | Direct comp. | Indirect comp. |
|---|---|---|---|
| Cigna Health And Life Insurance | NONE | $212,780 | not reported in the loaded dataset |
| Meritain Health, Inc. | NONE | $72,680 | not reported in the loaded dataset |
| Cbiz Benefits & Insurance Services | NONE | $0 | $21,974 |
| Eyemed Vision Care | NONE | $13,285 | not reported in the loaded dataset |