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Form 5500 · Employee benefit plan · NORFOLK, VA

BOARD OF TRUSTEES - ATLANTIC COAST HEALTH PLAN

The filing calls this plan ATLANTIC COAST HEALTH PLAN.

BOARD OF TRUSTEES - ATLANTIC COAST HEALTH PLAN of NORFOLK, VA spreads its employee benefits across 4 insurance carriers, according to its Form 5500 Schedule A. Coverage is written through THE UNION LABOR LIFE INSURANCE COMPANY and 3 other carriers. The plan's most recent policy period ended in June.

Benefits broker of record
Not disclosed
Policy year ends
Juneas filed for plan year 2025

Sourced from U.S. DOL EFAST2 Form 5500 · EIN 54-0806028 · plan 502 · plan year 2025, filed Apr 15, 2026

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How this plan is funded

Self-funded as reported

The filing reports benefits paid from the plan's own money, and no medical insurance contract on Schedule A.

A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.

All participants at the start of the year
40
Active at start of year
40
Active at end of year
38
Disclosed commissions
$0
Typical renewal
July 1

Benefits declared on this filing

Healthdeclared, not on Schedule A
Dentaldeclared, not on Schedule A
Visiondeclared, not on Schedule A
Lifeinsured — AMERICAN UNITED LIFE INSURANCE COMPANY38 of 40 participants (95%) on the largest contract
Disabilityinsured — UNUM LIFE INSURANCE COMPANY OF AMERICA38 of 40 participants (95%)

Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.

Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.

Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.

Plan brief

Schedule A lists 4 insured contracts covering life, disability and stop-loss; the largest, with THE UNION LABOR LIFE INSURANCE COMPANY, covers 38 people.

The filing declares life, disability, health, dental and vision. Health, dental and vision appear with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.

The only insured piece of the health benefit is stop-loss coverage, and the filing reports the plan paying its own claims. The stop-loss contract reports $100,991 in premium and $0 in commission. The rest of the premium and commission above is on the plan's other insured lines, and none of it is medical premium.

Reported premium is $140,066; the filing discloses no broker commission on these contracts.

The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.

Schedule A insurance contracts

CarrierBenefitsCoveredRenewsPremiumCommission
THE UNION LABOR LIFE INSURANCE COMPANYStop-loss38Jul 1, 2025$100,991$0
AMERICAN UNITED LIFE INSURANCE COMPANYLife38Jul 1, 2025$19,957$0
UNUM LIFE INSURANCE COMPANY OF AMERICADisability38Jul 1, 2025$17,242$0
FORT DEARBORN LIFE INSURANCE COMPANYLife38Jul 1, 2025$1,876$0

Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.

See the filing at the Department of Labor

Administrator and service providers

Plan administrator on the filing
BOARD OF TRUSTEES - ATLANTIC COAST HEALTH PLAN
EIN 54-0806028

The plan administrator is from line 3a of the main form. We publish company names only.

Money the plan held and paid out

Plan assets at year end
$2,614,230
Paid out in benefits
$1,493,147

Sourced from U.S. DOL EFAST2 Form 5500 · Schedule I

These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.

How this plan compares

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BOARD OF TRUSTEES - ATLANTIC COAST HEALTH PLAN — carrier, renewal date · Form5500Lookup