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| Plan Name | DODGE CITY MEDICAL CENTER CHARTERED CAFETERIA PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | DODGE CITY MEDICAL CENTER CHARTERED |
| Employer identification number (EIN): | 481092267 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2018-07-01 | ||||
| 501 | 2017-07-01 | ||||
| 501 | 2015-07-01 | ||||
| 501 | 2014-11-01 |
| Measure | Date | Value |
|---|---|---|
| 2014: DODGE CITY MEDICAL CENTER CHARTERED CAFETERIA PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-11-01 | 96 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 96 |
| Total of all active and inactive participants | 2014-11-01 | 96 |
| 2014: DODGE CITY MEDICAL CENTER CHARTERED CAFETERIA PLAN 2014 form 5500 responses | ||
|---|---|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| BLUE CROSS BLUE SHIELD OF KANSAS (National Association of Insurance Commissioners NAIC id number: 70729 ) | |
| Policy contract number | 09416 |
| Policy instance | 1 |
| ADVANCE INSURANCE COMPANY OF KANSAS (National Association of Insurance Commissioners NAIC id number: 12143 ) | |
| Policy contract number | 00009416 |
| Policy instance | 2 |
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