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KANSAS SURGERY & RECOVERY CENTER, LLC AD&D 401k Plan overview

Plan NameKANSAS SURGERY & RECOVERY CENTER, LLC AD&D
Plan identification number 504

KANSAS SURGERY & RECOVERY CENTER, LLC AD&D Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

KANSAS SURGERY & RECOVERY CENTER, LLC. has sponsored the creation of one or more 401k plans.

Company Name:KANSAS SURGERY & RECOVERY CENTER, LLC.
Employer identification number (EIN):481148580
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KANSAS SURGERY & RECOVERY CENTER, LLC AD&D

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042019-01-01ASHLEY SIMON2020-09-25
5042019-01-01ASHLEY SIMON2021-01-19
5042019-01-01ASHLEY SIMON2021-10-11
5042018-01-01
5042017-01-01

Plan Statistics for KANSAS SURGERY & RECOVERY CENTER, LLC AD&D

401k plan membership statisitcs for KANSAS SURGERY & RECOVERY CENTER, LLC AD&D

Measure Date Value
2019: KANSAS SURGERY & RECOVERY CENTER, LLC AD&D 2019 401k membership
Total participants, beginning-of-year2019-01-01169
Total number of active participants reported on line 7a of the Form 55002019-01-01169
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01169
Number of employers contributing to the scheme2019-01-010
2018: KANSAS SURGERY & RECOVERY CENTER, LLC AD&D 2018 401k membership
Total participants, beginning-of-year2018-01-01158
Total number of active participants reported on line 7a of the Form 55002018-01-01169
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01169
Number of employers contributing to the scheme2018-01-010
2017: KANSAS SURGERY & RECOVERY CENTER, LLC AD&D 2017 401k membership
Total participants, beginning-of-year2017-01-01151
Total number of active participants reported on line 7a of the Form 55002017-01-01158
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01158

Form 5500 Responses for KANSAS SURGERY & RECOVERY CENTER, LLC AD&D

2019: KANSAS SURGERY & RECOVERY CENTER, LLC AD&D 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedYes
2019-01-01This submission is the final filingYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: KANSAS SURGERY & RECOVERY CENTER, LLC AD&D 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: KANSAS SURGERY & RECOVERY CENTER, LLC AD&D 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK605832
Policy instance 1
Insurance contract or identification numberSOK605832
Number of Individuals Covered169
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Welfare Benefit Premiums Paid to CarrierUSD $3,100
Commission paid to Insurance BrokerUSD $310
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK605832
Policy instance 1
Insurance contract or identification numberSOK605832
Number of Individuals Covered169
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $415
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $415
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK605832
Policy instance 1
Insurance contract or identification numberSOK605832
Number of Individuals Covered158
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $380
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,802
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $380
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC

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