401k Plan data: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN plan

SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 401k Plan overview

Plan Name	SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN
Plan identification number	001

SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT 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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).
Life insurance

401k Sponsoring company profile

SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. has sponsored the creation of one or more 401k plans.

Company Name: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC.

Employer identification number (EIN): 042530297

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 VINOD NARRA
001 2013-01-01 MARC RUBIN
001 2012-01-01 MARC RUBIN MARC RUBIN 2013-08-11
001 2011-01-01 MARC RUBIN
001 2010-01-01 MARC S. RUBIN, M.D. 2011-07-27 MARC S RUBIN M.D. 2011-07-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2014-01-01	VINOD NARRA
001	2013-01-01	MARC RUBIN
001	2012-01-01	MARC RUBIN		MARC RUBIN	2013-08-11
001	2011-01-01	MARC RUBIN
001	2010-01-01	MARC S. RUBIN, M.D.	2011-07-27	MARC S RUBIN M.D.	2011-07-27

Plan Statistics for SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN

401k plan membership statisitcs for SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN

Measure Date Value
2014: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 46
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 35
Total of all active and inactive participants 2014-01-01 44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 1
Total participants 2014-01-01 45
Number of participants with account balances 2014-01-01 45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 51
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 36
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 9
Total of all active and inactive participants 2013-01-01 45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 46
Number of participants with account balances 2013-01-01 45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 47
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 36
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 14
Total of all active and inactive participants 2012-01-01 50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 51
Number of participants with account balances 2012-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 45
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 2
Total of all active and inactive participants 2011-01-01 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 47
Number of participants with account balances 2011-01-01 41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2014: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	46
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	35
Total of all active and inactive participants	2014-01-01	44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	1
Total participants	2014-01-01	45
Number of participants with account balances	2014-01-01	45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	51
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	36
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	9
Total of all active and inactive participants	2013-01-01	45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	46
Number of participants with account balances	2013-01-01	45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	47
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	36
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	14
Total of all active and inactive participants	2012-01-01	50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	51
Number of participants with account balances	2012-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	45
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	2
Total of all active and inactive participants	2011-01-01	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	47
Number of participants with account balances	2011-01-01	41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN

Measure	Date	Value
2014 : SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$1,084,356
Expenses. Total of all expenses incurred	2014-12-31	$249,332
Benefits paid (including direct rollovers)	2014-12-31	$248,881
Total plan assets at end of year	2014-12-31	$10,197,379
Total plan assets at beginning of year	2014-12-31	$9,362,355
Value of fidelity bond covering the plan	2014-12-31	$1,000,000
Total contributions received or receivable from participants	2014-12-31	$190,342
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$192,867
Other income received	2014-12-31	$601,867
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$835,024
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$10,197,379
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$9,362,355
Assets. Value of participant loans	2014-12-31	$1,073
Total contributions received or receivable from employer(s)	2014-12-31	$99,280
Value of certain deemed distributions of participant loans	2014-12-31	$350
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$101
2013 : SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total income from all sources	2013-12-31	$2,196,253
Expenses. Total of all expenses incurred	2013-12-31	$275,885
Benefits paid (including direct rollovers)	2013-12-31	$275,560
Total plan assets at end of year	2013-12-31	$9,362,355
Total plan assets at beginning of year	2013-12-31	$7,441,987
Value of fidelity bond covering the plan	2013-12-31	$1,000,000
Total contributions received or receivable from participants	2013-12-31	$272,230
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$1,362,721
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$1,920,368
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$9,362,355
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$7,441,987
Assets. Value of participant loans	2013-12-31	$8,340
Total contributions received or receivable from employer(s)	2013-12-31	$561,302
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$325
2012 : SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$219,410
Total income from all sources	2012-12-31	$1,678,172
Expenses. Total of all expenses incurred	2012-12-31	$70,871
Benefits paid (including direct rollovers)	2012-12-31	$70,636
Total plan assets at end of year	2012-12-31	$7,441,987
Total plan assets at beginning of year	2012-12-31	$5,615,276
Value of fidelity bond covering the plan	2012-12-31	$1,000,000
Total contributions received or receivable from participants	2012-12-31	$301,885
Other income received	2012-12-31	$736,475
Net income (gross income less expenses)	2012-12-31	$1,607,301
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$7,441,987
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$5,615,276
Assets. Value of participant loans	2012-12-31	$3,517
Total contributions received or receivable from employer(s)	2012-12-31	$639,812
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$235
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$-59,738
Expenses. Total of all expenses incurred	2011-12-31	$34,901
Benefits paid (including direct rollovers)	2011-12-31	$34,901
Total plan assets at end of year	2011-12-31	$5,615,276
Total plan assets at beginning of year	2011-12-31	$5,709,915
Value of fidelity bond covering the plan	2011-12-31	$1,000,000
Total contributions received or receivable from participants	2011-12-31	$213,590
Other income received	2011-12-31	$-273,328
Net income (gross income less expenses)	2011-12-31	$-94,639
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$5,615,276
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$5,709,915
Assets. Value of participant loans	2011-12-31	$1,667
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0

Form 5500 Responses for SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT PLAN

2014: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT 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: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT 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 – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT 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 funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: SURGICAL SPECIALISTS OF THE NORTH SHORE, INC. RETIREMENT 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 funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

37006

Policy instance

Insurance contract or identification number	37006
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of fees paid to insurance company	USD $66
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	66
Additional information about fees paid to insurance broker	PERSISTENCY FEES AND OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	RALPH J. ROTMAN

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Company Name:	SURGICAL SPECIALISTS OF THE NORTH SHORE, INC.
Employer identification number (EIN):	042530297
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)