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| Plan Name | ANESTHESIA PAIN SERVICES, LLC 412(E)(3) DB PLAN |
| Plan identification number | 002 |
| 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 |
|---|---|---|---|---|---|
| 002 | 2013-01-01 | SHANE FANCHER | 2014-10-08 | SHANE FANCHER | 2014-10-08 |
| 002 | 2012-01-01 | SHANE FANCHER | SHANE FANCHER | 2013-04-09 |
| Measure | Date | Value |
|---|---|---|
| 2012: ANESTHESIA PAIN SERVICES, LLC 412(E)(3) DB PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-01-01 | 3 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 0 |
| 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 | 3 |
| Total of all active and inactive participants | 2012-01-01 | 3 |
| Total participants | 2012-01-01 | 3 |
| Measure | Date | Value |
|---|---|---|
| 2012 : ANESTHESIA PAIN SERVICES, LLC 412(E)(3) DB PLAN 2012 401k financial data | ||
| Total income from all sources | 2012-12-31 | $21,728 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $0 |
| Total plan assets at end of year | 2012-12-31 | $249,244 |
| Total plan assets at beginning of year | 2012-12-31 | $227,516 |
| Other income received | 2012-12-31 | $21,728 |
| Net income (gross income less expenses) | 2012-12-31 | $21,728 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $249,244 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $227,516 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2012-12-31 | $0 |
| 2012: ANESTHESIA PAIN SERVICES, LLC 412(E)(3) DB 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 is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Section 412(e)(3) insurance Contracts | Yes |
| 2012-01-01 | 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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