2023 Form 5500 filing — Ksb Hospital Veba Health Savings Plan
Plain-English filing summary
According to public Form 5500 filings published through the U.S. Department of Labor (DOL) Employee Benefits Security Administration (EBSA) via the EFAST2 system, this is the 2023 Form 5500 filing (EFAST2 acknowledgement 20241015144934NAL0014880387001) for Ksb Hospital Veba Health Savings Plan, reported by Katherine Shaw Bethea Hospital under EIN 36-1000540 and plan number 516. It reports 371 participants. Attached schedules in the loaded dataset include Schedule H (large plan financials), Schedule C (service provider compensation).
- EFAST2 acknowledgement
- 20241015144934NAL0014880387001
- Filing year
- 2023
- Form type
- 2
- Plan sponsor
- Katherine Shaw Bethea Hospital
- EIN
- 36-1000540
- Plan number
- 516
- Location
- Dixon, IL
- Participants
- 371
- Schedules available
- Schedule H, Schedule C
- Received date
- not reported in the loaded dataset
Reported financial snapshot (2023)
- Total assets (EOY)
- $0
- Total liabilities (EOY)
- $0
- Net assets (EOY)
- $0
- Participant contributions
- $2,983
- Total income / additions
- $3,527
- Benefits paid
- $1,702,641
- Administrative expenses
- $843
- Total expenses
- $1,703,484
- Net increase / (decrease)
- -$1,699,957
- Schedule source
- Schedule H
Reported service provider compensation (Schedule C)
| Provider | Service | Direct comp. | Indirect comp. |
|---|---|---|---|
| Total Administrative Services Corp. | NONE | $843 | not reported in the loaded dataset |