Form 5500 · Employee benefit plan · BLAIRSVILLE, PA
INTERNATIONAL CONVEYOR AND RUBBER, LLC
The filing calls this plan INTERNATIONAL CONVEYOR AND RUBBER HEALTH AND WELFARE PLAN.
INTERNATIONAL CONVEYOR AND RUBBER, LLC of BLAIRSVILLE, PA is a 134-participant construction employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is RELATION INSURANCE SERVICES OF NC. Coverage is written through THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA. The plan's most recent policy period ended in October.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 81-1661395 · plan 501 · plan year 2024, filed Mar 6, 2025
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
Also declared: death benefits, other welfare.
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.
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 1 insured contract covering health, dental, vision, life and disability; the largest, with THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA, covers 124 people.
Reported premium across the insured contracts is $147,832, with $24,591 in disclosed broker commissions — about 17% of premium.
The most recent policy period ended in October, and the plan year ends October 31. Group contracts typically renew on that annual cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Health, Dental, Vision, Life, Disability | 124 | Nov 1, 2024 | $147,832 | $24,591 |
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.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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