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| Plan Name | EVANSVILLE SURGICAL ASSOCIATES, INC. WELFARE BENEFIT PLAN |
| Plan identification number | 510 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | EVANSVILLE SURGICAL ASSOCIATES, INC. |
| Employer identification number (EIN): | 351171048 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 510 | 2018-01-01 | ||||
| 510 | 2017-01-01 | ||||
| 510 | 2016-01-01 | BRIAN SCHYMIK | |||
| 510 | 2015-01-01 | BRIAN SCHYMIK | |||
| 510 | 2014-01-01 | BRIAN SCHYMIK | |||
| 510 | 2013-01-01 | BRIAN SCHYMIK |
| 2018: EVANSVILLE SURGICAL ASSOCIATES, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses | ||
|---|---|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | This submission is the final filing | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: EVANSVILLE SURGICAL ASSOCIATES, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: EVANSVILLE SURGICAL ASSOCIATES, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses | ||
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: EVANSVILLE SURGICAL ASSOCIATES, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses | ||
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: EVANSVILLE SURGICAL ASSOCIATES, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses | ||
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: EVANSVILLE SURGICAL ASSOCIATES, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses | ||
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | First time form 5500 has been submitted | Yes |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) | |
| Policy contract number | 676295G |
| Policy instance | 1 |
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