401k Plan data: WEST BEND CLINIC, INC. 401(K) PLAN plan

WEST BEND CLINIC, INC. 401(K) PLAN 401k Plan overview

Plan Name	WEST BEND CLINIC, INC. 401(K) PLAN
Plan identification number	001

WEST BEND CLINIC, INC. 401(K) 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.
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.
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.
Plan sponsor(s) received services of leased employees, as defined in Code section 414(n), during the plan year.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

WEST BEND CLINIC, INC. has sponsored the creation of one or more 401k plans.

Company Name: WEST BEND CLINIC, INC.

Employer identification number (EIN): 392034294

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WEST BEND CLINIC, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2011-01-01 GREGORY BLOMMEL
001 2010-01-01 GREGORY BLOMMEL
001 2009-01-01 JAMES N. BROWNE

Plan id#	Filing Submission Date	Name of Administrator
001	2011-01-01	GREGORY BLOMMEL
001	2010-01-01	GREGORY BLOMMEL
001	2009-01-01	JAMES N. BROWNE

Plan Statistics for WEST BEND CLINIC, INC. 401(K) PLAN

401k plan membership statisitcs for WEST BEND CLINIC, INC. 401(K) PLAN

Measure Date Value
2011: WEST BEND CLINIC, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 195
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 0
Total of all active and inactive participants 2011-01-01 0
Total participants 2011-01-01 0
Number of participants with account balances 2011-01-01 0
2010: WEST BEND CLINIC, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 637
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 195
Total of all active and inactive participants 2010-01-01 195
Total participants 2010-01-01 195
Number of participants with account balances 2010-01-01 195
2009: WEST BEND CLINIC, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 624
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 605
Number of retired or separated participants receiving benefits 2009-01-01 2
Number of other retired or separated participants entitled to future benefits 2009-01-01 30
Total of all active and inactive participants 2009-01-01 637
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 637
Number of participants with account balances 2009-01-01 555
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 35

Measure	Date	Value
2011: WEST BEND CLINIC, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	195
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	0
Total of all active and inactive participants	2011-01-01	0
Total participants	2011-01-01	0
Number of participants with account balances	2011-01-01	0
2010: WEST BEND CLINIC, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	637
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	195
Total of all active and inactive participants	2010-01-01	195
Total participants	2010-01-01	195
Number of participants with account balances	2010-01-01	195
2009: WEST BEND CLINIC, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	624
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	605
Number of retired or separated participants receiving benefits	2009-01-01	2
Number of other retired or separated participants entitled to future benefits	2009-01-01	30
Total of all active and inactive participants	2009-01-01	637
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	637
Number of participants with account balances	2009-01-01	555
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	35

Financial Data on WEST BEND CLINIC, INC. 401(K) PLAN

Measure	Date	Value
2011 : WEST BEND CLINIC, INC. 401(K) PLAN 2011 401k financial data
Total transfer of assets from this plan	2011-02-27	$1,937,993
Total income from all sources (including contributions)	2011-02-27	$2,978
Value of total assets at end of year	2011-02-27	$0
Value of total assets at beginning of year	2011-02-27	$1,935,015
Total interest from all sources	2011-02-27	$2,978
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-02-27	No
Was this plan covered by a fidelity bond	2011-02-27	Yes
Value of fidelity bond cover	2011-02-27	$2,000,000
If this is an individual account plan, was there a blackout period	2011-02-27	No
Were there any nonexempt tranactions with any party-in-interest	2011-02-27	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-02-27	No
Value of net income/loss	2011-02-27	$2,978
Value of net assets at end of year (total assets less liabilities)	2011-02-27	$0
Value of net assets at beginning of year (total assets less liabilities)	2011-02-27	$1,935,015
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-02-27	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-02-27	No
Were any leases to which the plan was party in default or uncollectible	2011-02-27	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-02-27	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-02-27	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-02-27	$2,978
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-02-27	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-02-27	$1,935,015
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-02-27	No
Was there a failure to transmit to the plan any participant contributions	2011-02-27	No
Has the plan failed to provide any benefit when due under the plan	2011-02-27	No
Employer contributions (assets) at end of year	2011-02-27	$0
Employer contributions (assets) at beginning of year	2011-02-27	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-02-27	No
Did the plan have assets held for investment	2011-02-27	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-02-27	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-02-27	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-02-27	Yes
Opinion of an independent qualified public accountant for this plan	2011-02-27	Disclaimer
Accountancy firm name	2011-02-27	SCHENCK SC
Accountancy firm EIN	2011-02-27	391173131
2010 : WEST BEND CLINIC, INC. 401(K) PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$-344,785
Total unrealized appreciation/depreciation of assets	2010-12-31	$-344,785
Total transfer of assets from this plan	2010-12-31	$26,438,763
Total income from all sources (including contributions)	2010-12-31	$-292,186
Total of all expenses incurred	2010-12-31	$134,312
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$133,962
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$445
Value of total assets at end of year	2010-12-31	$1,935,015
Value of total assets at beginning of year	2010-12-31	$28,800,276
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$350
Total interest from all sources	2010-12-31	$52,154
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$2,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$2,090,775
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$445
Administrative expenses (other) incurred	2010-12-31	$350
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-426,498
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,935,015
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$28,800,276
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$22,803,145
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$52,154
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$1,935,015
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$2,711,225
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Employer contributions (assets) at end of year	2010-12-31	$0
Employer contributions (assets) at beginning of year	2010-12-31	$1,195,131
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$133,962
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	No
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
2009 : WEST BEND CLINIC, INC. 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for WEST BEND CLINIC, INC. 401(K) PLAN

2011: WEST BEND CLINIC, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	This submission is the final filing	Yes
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: WEST BEND CLINIC, INC. 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: WEST BEND CLINIC, INC. 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	WEST BEND CLINIC, INC.
Employer identification number (EIN):	392034294
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)