401k Plan data: THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN plan

THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN
Plan identification number	501

THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Health (other than dental or vision)
Life insurance
Dental
Vision
Long-term disability cover
Death benefits (include travel accident but not life insurance)
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

THE UROLOGY CENTER OF COLORADO, P.C has sponsored the creation of one or more 401k plans.

Company Name: THE UROLOGY CENTER OF COLORADO, P.C

Employer identification number (EIN): 840611814

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-07-01 KIMBERLEE SOUCIE 2024-01-11
501 2020-07-01 KIMBERLEE SOUCIE 2022-03-01
501 2020-07-01 KIMBERLEE SOUCIE 2023-03-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-07-01	KIMBERLEE SOUCIE	2024-01-11
501	2020-07-01	KIMBERLEE SOUCIE	2022-03-01
501	2020-07-01	KIMBERLEE SOUCIE	2023-03-09

Plan Statistics for THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 106
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 108
Number of retired or separated participants receiving benefits 2022-07-01 0
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 108
Number of employers contributing to the scheme 2022-07-01 0
2020: THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 104
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 100
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 100
Number of employers contributing to the scheme 2020-07-01 0

Measure	Date	Value
2022: THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	106
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	108
Number of retired or separated participants receiving benefits	2022-07-01	0
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	108
Number of employers contributing to the scheme	2022-07-01	0
2020: THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	104
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	100
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	100
Number of employers contributing to the scheme	2020-07-01	0

Form 5500 Responses for THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN

2022: THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: THE UROLOGY CENTER OF COLORADO EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	First time form 5500 has been submitted	Yes
2020-07-01	Submission has been amended	Yes
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3329645

Policy instance

Insurance contract or identification number	3329645
Number of Individuals Covered	108
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $10,320
Total amount of fees paid to insurance company	USD $74,573
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,616,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,306
Amount paid for insurance broker fees	45385
Additional information about fees paid to insurance broker	BENEFIT ADVISOR PAYMENTS
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD94049

Policy instance

Insurance contract or identification number	LTD94049
Number of Individuals Covered	30
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $16,095
Total amount of fees paid to insurance company	USD $180
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $115,116
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,322
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEE

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

KT024

Policy instance

Insurance contract or identification number	KT024
Number of Individuals Covered	47
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $8,785
Total amount of fees paid to insurance company	USD $447
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $58,159
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,837
Amount paid for insurance broker fees	305
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3329645

Policy instance

Insurance contract or identification number	3329645
Number of Individuals Covered	100
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $8,863
Total amount of fees paid to insurance company	USD $2,738
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,428,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,863
Amount paid for insurance broker fees	2738
Additional information about fees paid to insurance broker	SERVICE/GENERAL AGENT PAYMENTS
Insurance broker organization code?	3

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Company Name:	THE UROLOGY CENTER OF COLORADO, P.C
Employer identification number (EIN):	840611814
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)