401k Plan data: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN plan

MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 401k Plan overview

Plan Name	MAPLE GROVE ANESTHESIA SERVICES 401K PLAN
Plan identification number	001

MAPLE GROVE ANESTHESIA SERVICES 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Participant-directed brokerage accounts provided as an investment option under the plan.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

MAPLE GROVE ANESTHESIA SERVICES has sponsored the creation of one or more 401k plans.

Company Name: MAPLE GROVE ANESTHESIA SERVICES

Employer identification number (EIN): 264829907

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MAPLE GROVE ANESTHESIA SERVICES 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01 DANIEL HENSLEY 2021-07-15
001 2020-01-01
001 2019-01-01
001 2018-01-01 DANIEL HENSLEY
001 2017-01-01 DANIEL HENSLEY
001 2016-01-01 DANIEL HENSLEY
001 2015-01-01 DANIEL HENSLEY
001 2014-01-01 DANIEL HENSLEY
001 2013-01-01 DANIEL HENSLEY
001 2012-01-01 DANIEL HENSLEY
001 2011-01-01 DANIEL HENSLEY
001 2010-01-01 DANIEL HENSLEY
001 2009-07-01 DANIEL HENSLEY

Plan Statistics for MAPLE GROVE ANESTHESIA SERVICES 401K PLAN

401k plan membership statisitcs for MAPLE GROVE ANESTHESIA SERVICES 401K PLAN

Measure Date Value
2020: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 4
Number of retired or separated participants receiving benefits 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 1
Total of all active and inactive participants 2020-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 6
Number of participants with account balances 2020-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 13
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 13
Number of participants with account balances 2019-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 12
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 12
Number of participants with account balances 2018-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 11
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 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 11
Number of participants with account balances 2017-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 10
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 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 10
Number of participants with account balances 2016-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 8
Number of retired or separated participants receiving benefits 2015-01-01 1
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 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 9
Number of participants with account balances 2015-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 9
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 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 9
Number of participants with account balances 2014-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 9
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 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 9
Number of participants with account balances 2013-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 7
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 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 7
Number of participants with account balances 2012-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 5
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 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 5
Number of participants with account balances 2011-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 4
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 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 4
Number of participants with account balances 2010-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 4
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 4
Number of retired or separated participants receiving benefits 2009-07-01 0
Number of other retired or separated participants entitled to future benefits 2009-07-01 0
Total of all active and inactive participants 2009-07-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-07-01 0
Total participants 2009-07-01 4
Number of participants with account balances 2009-07-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-07-01 0

Measure	Date	Value
2020: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	4
Number of retired or separated participants receiving benefits	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	1
Total of all active and inactive participants	2020-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	6
Number of participants with account balances	2020-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	13
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	13
Number of participants with account balances	2019-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	12
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	12
Number of participants with account balances	2018-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	11
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	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	11
Number of participants with account balances	2017-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	10
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	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	10
Number of participants with account balances	2016-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	8
Number of retired or separated participants receiving benefits	2015-01-01	1
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	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	9
Number of participants with account balances	2015-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	9
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	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	9
Number of participants with account balances	2014-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	9
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	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	9
Number of participants with account balances	2013-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	7
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	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	7
Number of participants with account balances	2012-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	5
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	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	5
Number of participants with account balances	2011-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	4
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	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	4
Number of participants with account balances	2010-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	4
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	4
Number of retired or separated participants receiving benefits	2009-07-01	0
Number of other retired or separated participants entitled to future benefits	2009-07-01	0
Total of all active and inactive participants	2009-07-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-07-01	0
Total participants	2009-07-01	4
Number of participants with account balances	2009-07-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-07-01	0

Financial Data on MAPLE GROVE ANESTHESIA SERVICES 401K PLAN

Measure	Date	Value
2020 : MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2020 401k financial data
Total income from all sources	2020-12-31	$634,626
Expenses. Total of all expenses incurred	2020-12-31	$2,077,856
Benefits paid (including direct rollovers)	2020-12-31	$2,077,256
Total plan assets at end of year	2020-12-31	$2,613,176
Total plan assets at beginning of year	2020-12-31	$4,056,406
Value of fidelity bond covering the plan	2020-12-31	$405,641
Total contributions received or receivable from participants	2020-12-31	$171,208
Other income received	2020-12-31	$166,113
Net income (gross income less expenses)	2020-12-31	$-1,443,230
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$2,613,176
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$4,056,406
Assets. Value of participant loans	2020-12-31	$62,056
Assets. Value of assets in partnership/joint-venture interests	2020-12-31	$3,688
Total contributions received or receivable from employer(s)	2020-12-31	$297,305
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$600
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$1,345,059
Expenses. Total of all expenses incurred	2019-12-31	$25,175
Benefits paid (including direct rollovers)	2019-12-31	$25,000
Total plan assets at end of year	2019-12-31	$4,056,406
Total plan assets at beginning of year	2019-12-31	$2,736,522
Value of fidelity bond covering the plan	2019-12-31	$273,652
Total contributions received or receivable from participants	2019-12-31	$151,068
Other income received	2019-12-31	$657,666
Net income (gross income less expenses)	2019-12-31	$1,319,884
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$4,056,406
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$2,736,522
Assets. Value of participant loans	2019-12-31	$117,576
Assets. Value of assets in partnership/joint-venture interests	2019-12-31	$22,097
Total contributions received or receivable from employer(s)	2019-12-31	$536,325
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$175
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$77,569
Expenses. Total of all expenses incurred	2018-12-31	$125,025
Benefits paid (including direct rollovers)	2018-12-31	$125,000
Total plan assets at end of year	2018-12-31	$2,736,522
Total plan assets at beginning of year	2018-12-31	$2,783,978
Value of fidelity bond covering the plan	2018-12-31	$278,397
Total contributions received or receivable from participants	2018-12-31	$167,832
Other income received	2018-12-31	$-419,565
Net income (gross income less expenses)	2018-12-31	$-47,456
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$2,736,522
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$2,783,978
Assets. Value of participant loans	2018-12-31	$102,827
Assets. Value of assets in partnership/joint-venture interests	2018-12-31	$30,819
Total contributions received or receivable from employer(s)	2018-12-31	$329,302
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$25
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$467,185
Expenses. Total of all expenses incurred	2017-12-31	$100,650
Benefits paid (including direct rollovers)	2017-12-31	$100,000
Total plan assets at end of year	2017-12-31	$2,783,978
Total plan assets at beginning of year	2017-12-31	$2,417,443
Value of fidelity bond covering the plan	2017-12-31	$241,744
Total contributions received or receivable from participants	2017-12-31	$139,376
Other income received	2017-12-31	$147,810
Net income (gross income less expenses)	2017-12-31	$366,535
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$2,783,978
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$2,417,443
Assets. Value of participant loans	2017-12-31	$124,567
Assets. Value of assets in partnership/joint-venture interests	2017-12-31	$32,235
Total contributions received or receivable from employer(s)	2017-12-31	$179,999
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$650
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$821,717
Expenses. Total of all expenses incurred	2016-12-31	$6,229
Benefits paid (including direct rollovers)	2016-12-31	$6,204
Total plan assets at end of year	2016-12-31	$2,417,443
Total plan assets at beginning of year	2016-12-31	$1,601,955
Value of fidelity bond covering the plan	2016-12-31	$241,744
Total contributions received or receivable from participants	2016-12-31	$114,809
Other income received	2016-12-31	$402,602
Net income (gross income less expenses)	2016-12-31	$815,488
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$2,417,443
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,601,955
Assets. Value of participant loans	2016-12-31	$38,342
Assets. Value of assets in partnership/joint-venture interests	2016-12-31	$12,474
Total contributions received or receivable from employer(s)	2016-12-31	$304,306
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$25
2015 : MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$259,469
Expenses. Total of all expenses incurred	2015-12-31	$432,246
Benefits paid (including direct rollovers)	2015-12-31	$431,896
Total plan assets at end of year	2015-12-31	$1,601,955
Total plan assets at beginning of year	2015-12-31	$1,774,732
Value of fidelity bond covering the plan	2015-12-31	$177,473
Total contributions received or receivable from participants	2015-12-31	$85,823
Other income received	2015-12-31	$-91,000
Net income (gross income less expenses)	2015-12-31	$-172,777
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,601,955
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,774,732
Assets. Value of participant loans	2015-12-31	$50,384
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$40,310
Total contributions received or receivable from employer(s)	2015-12-31	$264,646
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$350
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$397,208
Expenses. Total of all expenses incurred	2014-12-31	$211,225
Benefits paid (including direct rollovers)	2014-12-31	$211,025
Total plan assets at end of year	2014-12-31	$1,774,732
Total plan assets at beginning of year	2014-12-31	$1,588,749
Value of fidelity bond covering the plan	2014-12-31	$158,875
Total contributions received or receivable from participants	2014-12-31	$88,708
Other income received	2014-12-31	$48,180
Net income (gross income less expenses)	2014-12-31	$185,983
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,774,732
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,588,749
Assets. Value of participant loans	2014-12-31	$16,700
Assets. Value of assets in partnership/joint-venture interests	2014-12-31	$87,524
Total contributions received or receivable from employer(s)	2014-12-31	$260,320
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$200
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$533,973
Expenses. Total of all expenses incurred	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$1,588,749
Total plan assets at beginning of year	2013-12-31	$1,054,776
Value of fidelity bond covering the plan	2013-12-31	$105,477
Total contributions received or receivable from participants	2013-12-31	$111,233
Other income received	2013-12-31	$217,519
Net income (gross income less expenses)	2013-12-31	$533,973
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,588,749
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,054,776
Assets. Value of assets in partnership/joint-venture interests	2013-12-31	$168,763
Total contributions received or receivable from employer(s)	2013-12-31	$205,221
2012 : MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$294,674
Expenses. Total of all expenses incurred	2012-12-31	$947
Total plan assets at end of year	2012-12-31	$1,054,776
Total plan assets at beginning of year	2012-12-31	$761,049
Value of fidelity bond covering the plan	2012-12-31	$50,000
Total contributions received or receivable from participants	2012-12-31	$85,000
Other income received	2012-12-31	$54,574
Net income (gross income less expenses)	2012-12-31	$293,727
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,054,776
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$761,049
Assets. Value of participant loans	2012-12-31	$32,381
Assets. Value of assets in partnership/joint-venture interests	2012-12-31	$240,789
Total contributions received or receivable from employer(s)	2012-12-31	$155,100
Value of corrective distributions	2012-12-31	$947
2011 : MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$374,772
Expenses. Total of all expenses incurred	2011-12-31	$150
Total plan assets at end of year	2011-12-31	$761,049
Total plan assets at beginning of year	2011-12-31	$386,427
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$66,000
Contributions received from other sources (not participants or employers)	2011-12-31	$156,322
Other income received	2011-12-31	$15,100
Net income (gross income less expenses)	2011-12-31	$374,622
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$761,049
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$386,427
Assets. Value of participant loans	2011-12-31	$39,736
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$251,241
Total contributions received or receivable from employer(s)	2011-12-31	$137,350
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$150
2010 : MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$213,436
Expenses. Total of all expenses incurred	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$386,427
Total plan assets at beginning of year	2010-12-31	$172,991
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$66,000
Other income received	2010-12-31	$17,436
Net income (gross income less expenses)	2010-12-31	$213,436
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$386,427
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$172,991
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$204,373
Total contributions received or receivable from employer(s)	2010-12-31	$130,000

Form 5500 Responses for MAPLE GROVE ANESTHESIA SERVICES 401K PLAN

2020: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: MAPLE GROVE ANESTHESIA SERVICES 401K 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 – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: MAPLE GROVE ANESTHESIA SERVICES 401K 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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: MAPLE GROVE ANESTHESIA SERVICES 401K 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: MAPLE GROVE ANESTHESIA SERVICES 401K 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: MAPLE GROVE ANESTHESIA SERVICES 401K 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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: MAPLE GROVE ANESTHESIA SERVICES 401K 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: MAPLE GROVE ANESTHESIA SERVICES 401K 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: MAPLE GROVE ANESTHESIA SERVICES 401K 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 – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: MAPLE GROVE ANESTHESIA SERVICES 401K PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Submission has been amended	No
2009-07-01	This submission is the final filing	No
2009-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2009-07-01	Plan is a collectively bargained plan	No
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes

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Company Name:	MAPLE GROVE ANESTHESIA SERVICES
Employer identification number (EIN):	264829907
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2021-01-01	DANIEL HENSLEY	2021-07-15
001	2020-01-01
001	2019-01-01
001	2018-01-01	DANIEL HENSLEY
001	2017-01-01	DANIEL HENSLEY
001	2016-01-01	DANIEL HENSLEY
001	2015-01-01	DANIEL HENSLEY
001	2014-01-01	DANIEL HENSLEY
001	2013-01-01	DANIEL HENSLEY
001	2012-01-01	DANIEL HENSLEY
001	2011-01-01	DANIEL HENSLEY
001	2010-01-01	DANIEL HENSLEY
001	2009-07-01	DANIEL HENSLEY