401k Plan data: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN plan

UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 401k Plan overview

Plan Name	UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN
Plan identification number	525

UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

AGILITI HEALTH, INC. has sponsored the creation of one or more 401k plans.

Company Name: AGILITI HEALTH, INC.

Employer identification number (EIN): 410760940

NAIC Classification: 621900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
525 2015-01-01 KRIS DUNLAP
525 2015-01-01 KRIS DUNLAP
525 2014-01-01 KRIS DUNLAP KRIS DUNLAP 2015-07-29
525 2013-01-01 KRIS DUNLAP KRIS DUNLAP 2014-07-20
525 2011-01-01 KATHLEEN HAWKINS
525 2010-01-01 KATHLEEN HAWKINS
525 2009-01-01 KATHLEEN HAWKINS

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
525	2015-01-01	KRIS DUNLAP
525	2015-01-01	KRIS DUNLAP
525	2014-01-01	KRIS DUNLAP	KRIS DUNLAP	2015-07-29
525	2013-01-01	KRIS DUNLAP	KRIS DUNLAP	2014-07-20
525	2011-01-01	KATHLEEN HAWKINS
525	2010-01-01	KATHLEEN HAWKINS
525	2009-01-01	KATHLEEN HAWKINS

Plan Statistics for UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN

401k plan membership statisitcs for UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN

Measure Date Value
2015: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 133
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 133
2014: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 130
Total of all active and inactive participants 2014-01-01 130
2013: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 126
Total of all active and inactive participants 2013-01-01 126
2011: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 96
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 96
2010: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 103
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 103
2009: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 179
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 122
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 122

Measure	Date	Value
2015: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	133
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	133
2014: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	130
Total of all active and inactive participants	2014-01-01	130
2013: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	126
Total of all active and inactive participants	2013-01-01	126
2011: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	96
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	96
2010: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	103
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	103
2009: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	179
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	122
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	122

Form 5500 Responses for UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN

2015: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2010: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: UNIVERSAL HOSPITAL SERVICES, INC. FLEXIBLE SPENDING ACCOUNT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Potentially related plans

UNIVERSAL HOSPITAL SYSTEM INC 401(K) [EIN = 455580751]

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Company Name:	AGILITI HEALTH, INC.
Employer identification number (EIN):	410760940
NAIC Classification:	621900