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| Plan Name | PLATTE HEALTH CENTER LIFE PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PLATTE COMMUNITY MEMORIAL HOSPITAL, INC. |
| Employer identification number (EIN): | 460239781 |
| NAIC Classification: | 622000 |
| NAIC Description: | Hospitals |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2023-01-01 | MARK BURKET | 2024-07-29 | VICKI JENSEN | 2024-07-29 |
| 503 | 2022-01-01 | MARK BURKET | 2023-08-11 | MARK BURKET | 2023-08-11 |
| 503 | 2021-01-01 | MARK BURKET | 2022-07-12 | VICKI JENSEN | 2022-07-12 |
| 503 | 2020-01-01 | MARK BURKET | 2021-07-27 | VICKI JENSEN | 2021-07-27 |
| 503 | 2019-01-01 | MARK BURKET | 2020-07-28 | VICKI JENSEN | 2020-07-28 |
| 503 | 2018-01-01 | ||||
| 503 | 2017-01-01 |
| 2023: PLATTE HEALTH CENTER LIFE PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: PLATTE HEALTH CENTER LIFE PLAN 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: PLATTE HEALTH CENTER LIFE PLAN 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: PLATTE HEALTH CENTER LIFE PLAN 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: PLATTE HEALTH CENTER LIFE PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: PLATTE HEALTH CENTER LIFE PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: PLATTE HEALTH CENTER LIFE PLAN 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) | |||||||||||||||||||||
| Policy contract number | 65129 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) | |||||||||||||||||||||
| Policy contract number | 65129 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| |||||||||||||||||||||
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) | |||||||||||||||||||||
| Policy contract number | 65129 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) | |||||||||||||||||||||
| Policy contract number | 65129 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) | |||||||||||||||||||||
| Policy contract number | 65129 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) | |||||||||||||||||||||
| Policy contract number | 65129 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
| KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 ) | |||||||||||||||||||||
| Policy contract number | 65129 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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