Form 5500 · Employee benefit plan · BLOOMINGTON, IN
STONE BELT ARC, INC.
The filing calls this plan STONE BELT HEALTH, DENTAL, AND VISION BENEFIT PLAN.
STONE BELT ARC, INC. of BLOOMINGTON, IN insures health, dental, vision, life and disability coverage for its employees, per Schedule A of its Form 5500. Its broker of record is HYLANT GROUP INC. Coverage is written through ANTHEM INSURANCE COMPANIES, INC. and 3 other carriers. The plan's most recent policy period ended in June.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 35-1059827 · plan 560 · plan year 2025, filed Jan 27, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
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 4 insured contracts covering health, dental, vision, life and disability; the largest, with ANTHEM INSURANCE COMPANIES, INC., covers 248 people.
Reported premium across the insured contracts is $2,193,978, with $67,936 in disclosed broker commissions — about 3.1% of premium.
The most recent policy period ended in June, and the plan year ends June 30. Group contracts typically renew on that annual cycle.
HYLANT GROUP INC is the broker of record on 2 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including ANTHEM INSURANCE COMPANIES, INC., AMERICAN UNITED LIFE INSURANCE COMPANY, UNITEDHEALTHCARE INSURANCE COMPANY and VISION SERVICE PLAN. ANTHEM INSURANCE COMPANIES, INC. writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| ANTHEM INSURANCE COMPANIES, INC. | Health | 248 | Jul 1, 2025 | $2,046,295 | $52,925 |
| AMERICAN UNITED LIFE INSURANCE COMPANY | Life, Disability | 91 | Jul 1, 2025 | $63,511 | $8,906 |
| UNITEDHEALTHCARE INSURANCE COMPANY | Dental | 248 | Jul 1, 2025 | $59,747 | $5,975 |
| VISION SERVICE PLAN | Vision | 181 | Jul 1, 2025 | $24,425 | $130 |
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.
Reported to OSHA
Reported to OSHA for 2025: 518 employees, 37 recordable cases, 18 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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