2023 Form 5500 filing — Klover Sepa, Inc. Group Medical 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 20241016144905NAL0030772145001) for Klover Sepa, Inc. Group Medical Plan, reported by Klover Sepa, Inc. under EIN 81-5335337 and plan number 502. It reports 138 participants. Attached schedules in the loaded dataset include Schedule H (large plan financials), Schedule C (service provider compensation).
- EFAST2 acknowledgement
- 20241016144905NAL0030772145001
- Filing year
- 2023
- Form type
- 2
- Plan sponsor
- Klover Sepa, Inc.
- EIN
- 81-5335337
- Plan number
- 502
- Location
- Quakertown, PA
- Participants
- 138
- Schedules available
- Schedule H, Schedule C
- Received date
- not reported in the loaded dataset
Reported financial snapshot (2023)
- Total assets (EOY)
- $222,653
- Total liabilities (EOY)
- $0
- Net assets (EOY)
- $222,653
- Employer contributions
- $915,614
- Participant contributions
- $273,980
- Total income / additions
- $1,194,240
- Benefits paid
- $1,018,271
- Administrative expenses
- $128,615
- Total expenses
- $1,146,886
- Net increase / (decrease)
- $47,354
- Schedule source
- Schedule H
Reported service provider compensation (Schedule C)
| Provider | Service | Direct comp. | Indirect comp. |
|---|---|---|---|
| Univest Insurance | BROKER | $42,840 | not reported in the loaded dataset |
| Engle-Hambright & Davies, Inc | BROKER | $40,755 | not reported in the loaded dataset |
| Independence Administrators | ADMIN | $21,021 | not reported in the loaded dataset |
| The Benecon Group, LLC | BROKER | $16,615 | not reported in the loaded dataset |
| Connectcare 3 | PATIENT ADVOCATE | $7,384 | not reported in the loaded dataset |