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| Plan Name | ANESTHESIA PAIN SERVICES 401(K) PLAN |
| Plan identification number | 001 |
| 401k Plan Type | Defined Benefit Pension |
| Plan Features/Benefits |
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| Company Name: | ANESTHESIA PAIN SERVICES LLC |
| Employer identification number (EIN): | 352297264 |
| 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 |
|---|---|---|---|---|---|
| 001 | 2017-01-01 | SHANE FANCHER | 2017-08-23 | SHANE FANCHER | 2017-08-23 |
| 001 | 2016-01-01 | SHANE FANCHER | 2017-06-15 | SHANE FANCHER | 2017-06-15 |
| 001 | 2015-01-01 | SHANE FANCHER | 2016-07-13 | SHANE FANCHER | 2016-07-13 |
| 001 | 2014-01-01 | SHANE FANCHER | 2015-06-30 | SHANE FANCHER | 2015-06-30 |
| 001 | 2013-01-01 | SHANE FANCHER | 2014-06-26 | ||
| 001 | 2012-01-01 | SHANE FANCHER | 2013-07-19 | ||
| 001 | 2011-01-01 | SHANE FANCHER | SHANE FANCHER | 2012-09-20 | |
| 001 | 2009-01-01 | SHANE FANCHER | SHANE FANCHER | 2010-09-30 |
| Measure | Date | Value |
|---|---|---|
| 2011: ANESTHESIA PAIN SERVICES 401(K) PLAN 2011 401k membership | ||
| Total participants, beginning-of-year | 2011-01-01 | 3 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 3 |
| Total of all active and inactive participants | 2011-01-01 | 3 |
| Total participants | 2011-01-01 | 3 |
| 2009: ANESTHESIA PAIN SERVICES 401(K) PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 3 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 3 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 3 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 3 |
| Measure | Date | Value |
|---|---|---|
| 2011 : ANESTHESIA PAIN SERVICES 401(K) PLAN 2011 401k financial data | ||
| Total income from all sources | 2011-12-31 | $-4,964 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $0 |
| Total plan assets at end of year | 2011-12-31 | $227,516 |
| Total plan assets at beginning of year | 2011-12-31 | $232,480 |
| Other income received | 2011-12-31 | $-4,964 |
| Net income (gross income less expenses) | 2011-12-31 | $-4,964 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $227,516 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $232,480 |
| 2010 : ANESTHESIA PAIN SERVICES 401(K) PLAN 2010 401k financial data | ||
| Total income from all sources | 2010-12-31 | $110,063 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $0 |
| Total plan assets at end of year | 2010-12-31 | $232,480 |
| Total plan assets at beginning of year | 2010-12-31 | $122,417 |
| Other income received | 2010-12-31 | $-10,889 |
| Net income (gross income less expenses) | 2010-12-31 | $110,063 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $232,480 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $122,417 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $120,952 |
| 2011: ANESTHESIA PAIN SERVICES 401(K) 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 – Section 412(e)(3) insurance Contracts | Yes |
| 2011-01-01 | Plan benefit arrangement – Section 412(e)(3) insurance Contracts | Yes |
| 2009: ANESTHESIA PAIN SERVICES 401(K) PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | First time form 5500 has been submitted | Yes |
| 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 – Section 412(e)(3) insurance Contracts | Yes |
| 2009-01-01 | Plan benefit arrangement – Section 412(e)(3) insurance Contracts | Yes |
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) | |||||||||||||||||||||||
| Policy contract number | 95901 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) | |||||||||||||||||||||||
| Policy contract number | 1006146 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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