Form 5500 · Employee benefit plan · SALEM, KY
LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC.
The filing calls this plan LIVINGSTON HOSPITAL HEALTHCARE/DENTAL PLAN.
LIVINGSTON HOSPITAL AND HEALTHCARE SERVICES, INC. of SALEM, KY insures dental, vision and stop-loss coverage for its employees, per Schedule A of its Form 5500. Its broker of record is HUB INTERNATIONAL MIDWEST LIMITED. Coverage is written through SUN LIFE ASSURANCE COMPANY OF CANADA and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 61-0518022 · plan 501 · plan year 2025, filed Jul 13, 2026
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How this plan is funded
Self-funded as reported
The filing reports a stop-loss contract and no medical premium, which is what a plan that pays its own claims reports.
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.
Benefits declared on this filing
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 3 insured contracts covering dental, vision and stop-loss; the largest, with SUN LIFE ASSURANCE COMPANY OF CANADA, covers 93 people.
The filing declares dental, vision and health. Health appears 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 $430,452 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 across the insured contracts is $506,108, with $2,766 in disclosed broker commissions — about 0.5% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| DELTA DENTAL OF KENTUCKY | Dental | 237 | Jan 1, 2026 | $62,841 | $1,493 |
| ANTHEM HEALTH PLANS OF KENTUCKY, INC. | Vision | 191 | Jan 1, 2026 | $12,815 | $1,273 |
| SUN LIFE ASSURANCE COMPANY OF CANADA | Stop-loss | 93 | Jan 1, 2026 | $430,452 | $0 |
Premium and claims on these contracts
DELTA DENTAL OF KENTUCKY, contract 697850. For the contract year on this filing, the carrier reported $62,841 in premium earned and $59,849 in claims incurred. Dividing one by the other gives 95%.
SUN LIFE ASSURANCE COMPANY OF CANADA, contract 965502. For the contract year on this filing, the carrier reported $430,452 in premium earned and $0 in claims incurred. Dividing one by the other gives 0%.
- DELTA DENTAL OF KENTUCKY, contract 697850 reported $8,182 in retention.
- SUN LIFE ASSURANCE COMPANY OF CANADA, contract 965502 reported $64,911 in retention.
Retention is what the carrier kept of the premium after claims, as reported: administration, commissions and other charges.
Only experience-rated contracts report these figures, so most filings leave them blank.
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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