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FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 401k Plan overview

Plan NameFOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN
Plan identification number 001

FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN Benefits

401k Plan TypeDefined 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.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

FOX VALLEY SURGICAL ASSOCIATES LTD has sponsored the creation of one or more 401k plans.

Company Name:FOX VALLEY SURGICAL ASSOCIATES LTD
Employer identification number (EIN):361141203
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01CHAD CARROLL2023-07-17
0012021-01-01BETH KRIEGER2022-08-26
0012020-01-01BETH KRIEGER2021-03-01
0012019-01-01BETH KRIEGER2020-10-08
0012018-01-01BETH KRIEGER, MD2019-05-30
0012017-01-01BETH KRIEGER, MD
0012016-01-01BETH KRIEGER, MD
0012015-01-01PHILIP VOGT
0012014-01-01PHILIP VOGT
0012013-01-01PHILIP VOGT
0012012-01-01PHILIP VOGT
0012011-01-01PHILIP VOGT
0012009-01-01PHILIP VOGT

Plan Statistics for FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN

401k plan membership statisitcs for FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN

Measure Date Value
2017: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0159
Total number of active participants reported on line 7a of the Form 55002017-01-0146
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-016
Total of all active and inactive participants2017-01-0152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0152
Number of participants with account balances2017-01-0152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-012
2016: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0156
Total number of active participants reported on line 7a of the Form 55002016-01-0147
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0112
Total of all active and inactive participants2016-01-0159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0159
Number of participants with account balances2016-01-0159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-014
2015: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0159
Total number of active participants reported on line 7a of the Form 55002015-01-0148
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-018
Total of all active and inactive participants2015-01-0156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0156
Number of participants with account balances2015-01-0156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-011
2014: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0159
Total number of active participants reported on line 7a of the Form 55002014-01-0144
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0115
Total of all active and inactive participants2014-01-0159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0159
Number of participants with account balances2014-01-0159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-011
2013: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0157
Total number of active participants reported on line 7a of the Form 55002013-01-0144
Number of retired or separated participants receiving benefits2013-01-0115
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0159
Number of participants with account balances2013-01-0159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-012
2012: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0156
Total number of active participants reported on line 7a of the Form 55002012-01-0143
Number of retired or separated participants receiving benefits2012-01-0114
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0157
Number of participants with account balances2012-01-0157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0148
Total number of active participants reported on line 7a of the Form 55002011-01-0144
Number of retired or separated participants receiving benefits2011-01-0112
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0156
Number of participants with account balances2011-01-0156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-012
2009: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0150
Total number of active participants reported on line 7a of the Form 55002009-01-0141
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0112
Total of all active and inactive participants2009-01-0153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0153
Number of participants with account balances2009-01-0153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-012

Financial Data on FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN

Measure Date Value
2017 : FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2017 401k financial data
Transfers to/from the plan2017-12-31$0
Total plan liabilities at end of year2017-12-31$0
Total plan liabilities at beginning of year2017-12-31$0
Total income from all sources2017-12-31$4,234,043
Expenses. Total of all expenses incurred2017-12-31$3,134,728
Benefits paid (including direct rollovers)2017-12-31$3,047,189
Total plan assets at end of year2017-12-31$23,132,005
Total plan assets at beginning of year2017-12-31$22,032,690
Value of fidelity bond covering the plan2017-12-31$500,000
Total contributions received or receivable from participants2017-12-31$355,628
Expenses. Other expenses not covered elsewhere2017-12-31$0
Contributions received from other sources (not participants or employers)2017-12-31$647
Other income received2017-12-31$3,277,186
Noncash contributions received2017-12-31$0
Net income (gross income less expenses)2017-12-31$1,099,315
Net plan assets at end of year (total assets less liabilities)2017-12-31$23,132,005
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$22,032,690
Assets. Value of participant loans2017-12-31$20,058
Assets. Value of assets in partnership/joint-venture interests2017-12-31$0
Total contributions received or receivable from employer(s)2017-12-31$600,582
Value of certain deemed distributions of participant loans2017-12-31$0
Value of corrective distributions2017-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$87,539
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2016 401k financial data
Transfers to/from the plan2016-12-31$0
Total plan liabilities at end of year2016-12-31$0
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$2,782,446
Expenses. Total of all expenses incurred2016-12-31$188,132
Benefits paid (including direct rollovers)2016-12-31$87,732
Total plan assets at end of year2016-12-31$22,032,690
Total plan assets at beginning of year2016-12-31$19,438,376
Value of fidelity bond covering the plan2016-12-31$500,000
Total contributions received or receivable from participants2016-12-31$324,684
Expenses. Other expenses not covered elsewhere2016-12-31$0
Contributions received from other sources (not participants or employers)2016-12-31$10,719
Other income received2016-12-31$1,882,462
Noncash contributions received2016-12-31$0
Net income (gross income less expenses)2016-12-31$2,594,314
Net plan assets at end of year (total assets less liabilities)2016-12-31$22,032,690
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$19,438,376
Assets. Value of participant loans2016-12-31$4,199
Assets. Value of assets in partnership/joint-venture interests2016-12-31$65,657
Total contributions received or receivable from employer(s)2016-12-31$564,581
Value of certain deemed distributions of participant loans2016-12-31$0
Value of corrective distributions2016-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$100,400
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2015 401k financial data
Transfers to/from the plan2015-12-31$0
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$1,003,209
Expenses. Total of all expenses incurred2015-12-31$6,323,079
Benefits paid (including direct rollovers)2015-12-31$6,224,042
Total plan assets at end of year2015-12-31$19,438,376
Total plan assets at beginning of year2015-12-31$24,758,246
Value of fidelity bond covering the plan2015-12-31$500,000
Total contributions received or receivable from participants2015-12-31$319,251
Expenses. Other expenses not covered elsewhere2015-12-31$0
Contributions received from other sources (not participants or employers)2015-12-31$7,072
Other income received2015-12-31$110,587
Noncash contributions received2015-12-31$0
Net income (gross income less expenses)2015-12-31$-5,319,870
Net plan assets at end of year (total assets less liabilities)2015-12-31$19,438,376
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$24,758,246
Assets. Value of participant loans2015-12-31$17,246
Assets. Value of assets in partnership/joint-venture interests2015-12-31$65,657
Total contributions received or receivable from employer(s)2015-12-31$566,299
Value of certain deemed distributions of participant loans2015-12-31$0
Value of corrective distributions2015-12-31$1,147
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$97,890
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$2,710,111
Expenses. Total of all expenses incurred2014-12-31$716,923
Benefits paid (including direct rollovers)2014-12-31$609,555
Total plan assets at end of year2014-12-31$24,758,246
Total plan assets at beginning of year2014-12-31$22,765,058
Value of fidelity bond covering the plan2014-12-31$500,000
Total contributions received or receivable from participants2014-12-31$308,301
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$56,432
Other income received2014-12-31$1,843,315
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$1,993,188
Net plan assets at end of year (total assets less liabilities)2014-12-31$24,758,246
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$22,765,058
Assets. Value of participant loans2014-12-31$20,790
Assets. Value of assets in partnership/joint-venture interests2014-12-31$65,657
Total contributions received or receivable from employer(s)2014-12-31$502,063
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$107,368
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$6,068,924
Expenses. Total of all expenses incurred2013-12-31$652,379
Benefits paid (including direct rollovers)2013-12-31$572,623
Total plan assets at end of year2013-12-31$22,765,058
Total plan assets at beginning of year2013-12-31$17,348,513
Value of fidelity bond covering the plan2013-12-31$500,000
Total contributions received or receivable from participants2013-12-31$277,950
Expenses. Other expenses not covered elsewhere2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$30,117
Other income received2013-12-31$5,282,856
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$5,416,545
Net plan assets at end of year (total assets less liabilities)2013-12-31$22,765,058
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$17,348,513
Assets. Value of participant loans2013-12-31$4,512
Assets. Value of assets in partnership/joint-venture interests2013-12-31$78,157
Total contributions received or receivable from employer(s)2013-12-31$478,001
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$79,756
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$0
Total income from all sources2012-12-31$2,878,394
Expenses. Total of all expenses incurred2012-12-31$193,669
Benefits paid (including direct rollovers)2012-12-31$120,649
Total plan assets at end of year2012-12-31$17,348,513
Total plan assets at beginning of year2012-12-31$14,663,788
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$247,649
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$53,293
Other income received2012-12-31$2,094,319
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$2,684,725
Net plan assets at end of year (total assets less liabilities)2012-12-31$17,348,513
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$14,663,788
Assets. Value of participant loans2012-12-31$9,559
Assets. Value of assets in partnership/joint-venture interests2012-12-31$78,157
Total contributions received or receivable from employer(s)2012-12-31$483,133
Value of certain deemed distributions of participant loans2012-12-31$10,080
Value of corrective distributions2012-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$62,940
2011 : FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$555,057
Expenses. Total of all expenses incurred2011-12-31$1,293,186
Benefits paid (including direct rollovers)2011-12-31$1,228,883
Total plan assets at end of year2011-12-31$14,663,788
Total plan assets at beginning of year2011-12-31$15,401,917
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$261,076
Contributions received from other sources (not participants or employers)2011-12-31$13,094
Other income received2011-12-31$-205,633
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$-738,129
Net plan assets at end of year (total assets less liabilities)2011-12-31$14,663,788
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$15,401,917
Assets. Value of participant loans2011-12-31$20,143
Assets. Value of assets in partnership/joint-venture interests2011-12-31$78,157
Total contributions received or receivable from employer(s)2011-12-31$486,520
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$64,303
2010 : FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$3,142,268
Expenses. Total of all expenses incurred2010-12-31$781,356
Benefits paid (including direct rollovers)2010-12-31$726,568
Total plan assets at end of year2010-12-31$15,401,917
Total plan assets at beginning of year2010-12-31$13,041,005
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$245,139
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$38,618
Other income received2010-12-31$2,380,461
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$2,360,912
Net plan assets at end of year (total assets less liabilities)2010-12-31$15,401,917
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$13,041,005
Assets. Value of participant loans2010-12-31$4,815
Assets. Value of assets in partnership/joint-venture interests2010-12-31$78,157
Total contributions received or receivable from employer(s)2010-12-31$478,050
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$54,788

Form 5500 Responses for FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN

2017: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: FOX VALLEY SURGICAL ASSOCIATES LTD 401K PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number21879
Policy instance 1
Insurance contract or identification number21879
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number21879
Policy instance 1
Insurance contract or identification number21879
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
LINCOLN BENEFIT LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 65595 )
Policy contract numberU0185696
Policy instance 1
Insurance contract or identification numberU0185696
Number of Individuals Covered0
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number21879
Policy instance 2
Insurance contract or identification number21879
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
LINCOLN BENEFIT LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 65595 )
Policy contract numberU0185696
Policy instance 1
Insurance contract or identification numberU0185696
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number21879
Policy instance 2
Insurance contract or identification number21879
Number of Individuals Covered2
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
LINCOLN BENEFIT LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 65595 )
Policy contract numberU0185696
Policy instance 1
Insurance contract or identification numberU0185696
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number21879
Policy instance 2
Insurance contract or identification number21879
Number of Individuals Covered2
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
LINCOLN BENEFIT LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 65595 )
Policy contract numberU0185696
Policy instance 1
Insurance contract or identification numberU0185696
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number21879
Policy instance 2
Insurance contract or identification number21879
Number of Individuals Covered2
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number21879
Policy instance 2
Insurance contract or identification number21879
Number of Individuals Covered2
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
LINCOLN BENEFIT LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 65595 )
Policy contract numberU0185696
Policy instance 1
Insurance contract or identification numberU0185696
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No

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