401k Plan data: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN plan

70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 401k Plan overview

Plan Name	70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN
Plan identification number	505

70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover

401k Sponsoring company profile

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

Company Name: LINCOLN SURGERY CENTER, LLC

Employer identification number (EIN): 470807324

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about LINCOLN SURGERY CENTER, LLC

Jurisdiction of Incorporation: Colorado Department of State

Incorporation Date: 2008-01-21

Company Identification Number: 20081040521

Legal Registered Office Address: 11960 Lioness Way Ste 120

Parker
United States of America (USA)
80134

More information about LINCOLN SURGERY CENTER, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2017-01-01 ROBIN F LINAFELTER ROBIN F LINAFELTER 2018-07-25
505 2017-01-01
505 2016-01-01 ROBIN LINAFELTER ROBIN LINAFELTER 2017-07-27
505 2015-01-01 ROBIN LINAFELTER ROBIN LINAFELTER 2016-07-22
505 2014-01-01 ROBIN LINAFELTER ROBIN LINAFELTER 2015-07-28
505 2013-01-01 ROBIN LINAFEFLTER ROBIN LINAFEFLTER 2014-07-16
505 2012-01-01 ROBIN LINAFELTER ROBIN LINAFELTER 2013-07-18
505 2011-01-01 ROBIN LINAFELTER ROBIN LINAFELTER 2012-07-20

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
505	2017-01-01	ROBIN F LINAFELTER	ROBIN F LINAFELTER	2018-07-25
505	2017-01-01
505	2016-01-01	ROBIN LINAFELTER	ROBIN LINAFELTER	2017-07-27
505	2015-01-01	ROBIN LINAFELTER	ROBIN LINAFELTER	2016-07-22
505	2014-01-01	ROBIN LINAFELTER	ROBIN LINAFELTER	2015-07-28
505	2013-01-01	ROBIN LINAFEFLTER	ROBIN LINAFEFLTER	2014-07-16
505	2012-01-01	ROBIN LINAFELTER	ROBIN LINAFELTER	2013-07-18
505	2011-01-01	ROBIN LINAFELTER	ROBIN LINAFELTER	2012-07-20

Plan Statistics for 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN

401k plan membership statisitcs for 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN

Measure Date Value
2017: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 141
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 141
2016: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 141
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 141
2015: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 138
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 2015-01-01 138
2014: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 131
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 131
2013: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 117
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 117
2012: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 102
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 102
2011: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 100
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 2011-01-01 100

Measure	Date	Value
2017: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	141
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	141
2016: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	141
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	141
2015: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	138
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	138
2014: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	131
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	131
2013: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	117
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	117
2012: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	102
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	102
2011: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	100
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	100

Form 5500 Responses for 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN

2017: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT 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 – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT 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 – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT 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 – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: 70TH STREET PROPERTIES VOLUNTARY LONG TERM DISABIL ITY BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
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 – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT960588

Policy instance

Insurance contract or identification number	VDT960588
Number of Individuals Covered	141
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,460
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $38,294
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,460
Insurance broker organization code?	3
Insurance broker name	SILVERSTONE GROUP, INC

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Company Name:	LINCOLN SURGERY CENTER, LLC
Employer identification number (EIN):	470807324
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	Colorado Department of State
Incorporation Date:	2008-01-21
Company Identification Number:	20081040521
Legal Registered Office Address:	11960 Lioness Way Ste 120 Parker United States of America (USA) 80134