401k Plan data: ENVISION HEALTHCARE OPERATING, INC. WELFARE BENEFIT PLAN plan

ENVISION HEALTHCARE OPERATING, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	ENVISION HEALTHCARE OPERATING, INC. WELFARE BENEFIT PLAN
Plan identification number	501

ENVISION HEALTHCARE OPERATING, INC. 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 Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

ENVISION HEALTHCARE OPERATING, INC. has sponsored the creation of one or more 401k plans.

Company Name: ENVISION HEALTHCARE OPERATING, INC.

Employer identification number (EIN): 934099984

NAIC Classification: 621493
NAIC Description: Freestanding Ambulatory Surgical and Emergency Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ENVISION HEALTHCARE OPERATING, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 MICHELLE COTTON 2024-07-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	MICHELLE COTTON	2024-07-23

Plan Statistics for ENVISION HEALTHCARE OPERATING, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for ENVISION HEALTHCARE OPERATING, INC. WELFARE BENEFIT PLAN

Measure Date Value
2023: ENVISION HEALTHCARE OPERATING, INC. WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 18,027
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 17,218
Number of retired or separated participants receiving benefits 2023-01-01 252
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 17,470
Number of employers contributing to the scheme 2023-01-01 0

Measure	Date	Value
2023: ENVISION HEALTHCARE OPERATING, INC. WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	18,027
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	17,218
Number of retired or separated participants receiving benefits	2023-01-01	252
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	17,470
Number of employers contributing to the scheme	2023-01-01	0

Form 5500 Responses for ENVISION HEALTHCARE OPERATING, INC. WELFARE BENEFIT PLAN

2023: ENVISION HEALTHCARE OPERATING, INC. WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Mulitple 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

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

3342980

Policy instance

Insurance contract or identification number	3342980
Number of Individuals Covered	4961
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $127,329
Total amount of fees paid to insurance company	USD $8,457
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,585,786
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )

Policy contract number

W3125

Policy instance

Insurance contract or identification number	W3125
Number of Individuals Covered	20805
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 $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HYATT LEGAL PLANS (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

1500495

Policy instance

Insurance contract or identification number	1500495
Number of Individuals Covered	1869
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $47,095
Total amount of fees paid to insurance company	USD $9,836
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $279,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COUNSELING GLOBAL DOMESTIC (National Association of Insurance Commissioners NAIC id number: 54161 )

Policy contract number

Policy instance

Insurance contract or identification number	00
Number of Individuals Covered	17218
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 $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $277,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

FLX0980511

Policy instance

Insurance contract or identification number	FLX0980511
Number of Individuals Covered	15746
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 $1,438
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM,ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $11,762,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

10135511001

Policy instance

Insurance contract or identification number	10135511001
Number of Individuals Covered	21675
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 $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $1,735,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

236997

Policy instance

Insurance contract or identification number	236997
Number of Individuals Covered	2835
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $84,326
Total amount of fees paid to insurance company	USD $12,668
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	CRITICAL ILLNESS,ACCIDENT,HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $4,857,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ENVISION HEALTHCARE OPERATING, INC.
Employer identification number (EIN):	934099984
NAIC Classification:	621493
NAIC Description:	Freestanding Ambulatory Surgical and Emergency Centers