401k Plan data: SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT PLAN plan

SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number	505

SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Prepaid legal Long-term disability cover

401k Sponsoring company profile

SALINA REGIONAL HEALTH CENTER has sponsored the creation of one or more 401k plans.

Company Name: SALINA REGIONAL HEALTH CENTER

Employer identification number (EIN): 481169103

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2023-01-01 BRENDA COX 2024-10-01 BRENDA COX 2024-10-01
505 2022-01-01 BRENDA COX 2023-10-10 BRENDA COX 2023-10-10
505 2021-01-01 BRENDA COX 2022-10-17
505 2020-01-01 BRENDA COX 2021-10-06
505 2019-01-01 BRENDA COX 2020-10-12
505 2018-01-01
505 2017-01-01 BRENDA COX

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2023-01-01	BRENDA COX	2024-10-01	BRENDA COX	2024-10-01
505	2022-01-01	BRENDA COX	2023-10-10	BRENDA COX	2023-10-10
505	2021-01-01	BRENDA COX	2022-10-17
505	2020-01-01	BRENDA COX	2021-10-06
505	2019-01-01	BRENDA COX	2020-10-12
505	2018-01-01
505	2017-01-01	BRENDA COX

Form 5500 Responses for SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT PLAN

2023: SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: SALINA REGIONAL HEALTH CENTER EMPLOYEE WELFARE BENEFIT 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 funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

16-015950-000

Policy instance

Insurance contract or identification number	16-015950-000
Number of Individuals Covered	1498
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $32,569
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $867,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0358800000

Policy instance

Insurance contract or identification number	0358800000
Number of Individuals Covered	183
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $12,560
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00563806

Policy instance

Insurance contract or identification number	00563806
Number of Individuals Covered	838
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $65,266
Total amount of fees paid to insurance company	USD $9,293
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CANCER, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $356,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

681500G

Policy instance

Insurance contract or identification number	681500G
Number of Individuals Covered	2687
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $78,992
Total amount of fees paid to insurance company	USD $42,906
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $869,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

AF15-0265-21

Policy instance

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

681500G

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00563806

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00563806

Policy instance

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

681500G

Policy instance

AMERICAN FIDELITY ASSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 60410 )

Policy contract number

AF15-0265-21

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00563806

Policy instance

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

681500G

Policy instance

IRONSHORE INDEMNITY INC. (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

ERR000308-02

Policy instance

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

681500G

Policy instance

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E4774170

Policy instance

VISION CARE DIRECT OF KANSAS (National Association of Insurance Commissioners NAIC id number: 0 )

Policy contract number

3663

Policy instance

IRONSHORE INDEMNITY INC. (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

ERR000308-01

Policy instance

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0283652

Policy instance

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

ERR1089-18

Policy instance

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52210,52211

Policy instance

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0283652

Policy instance

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

0283652

Policy instance

DELTA DENTAL OF KANSAS (National Association of Insurance Commissioners NAIC id number: 54615 )

Policy contract number

52210,52211

Policy instance

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

ERR1089-17

Policy instance

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Company Name:	SALINA REGIONAL HEALTH CENTER
Employer identification number (EIN):	481169103
NAIC Classification:	622000
NAIC Description:	Hospitals