401k Plan data: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST plan

NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 401k Plan overview

Plan Name	NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST
Plan identification number	004

NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 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.

401k Sponsoring company profile

NORTHWEST SUBURBAN ANESTHESIOLOGIST has sponsored the creation of one or more 401k plans.

Company Name: NORTHWEST SUBURBAN ANESTHESIOLOGIST

Employer identification number (EIN): 362777288

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
004 2014-01-01 MARCO FERNANDEZ 2015-08-12
004 2013-01-01 MARCO FERNANDEZ
004 2012-01-01 FIAZ AHMED
004 2011-01-01 FIAZ AHMED
004 2009-01-01 FIAZ AHMED

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
004	2014-01-01	MARCO FERNANDEZ	2015-08-12
004	2013-01-01	MARCO FERNANDEZ
004	2012-01-01	FIAZ AHMED
004	2011-01-01	FIAZ AHMED
004	2009-01-01	FIAZ AHMED

Plan Statistics for NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST

401k plan membership statisitcs for NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST

Measure Date Value
2013: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 31
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 29
Total of all active and inactive participants 2013-01-01 29
Total participants 2013-01-01 29
Number of participants with account balances 2013-01-01 29
2012: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 27
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 31
Total of all active and inactive participants 2012-01-01 31
Total participants 2012-01-01 31
Number of participants with account balances 2012-01-01 31
2011: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 27
Total of all active and inactive participants 2011-01-01 27
Total participants 2011-01-01 27
Number of participants with account balances 2011-01-01 27
2009: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 35
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 28
Number of retired or separated participants receiving benefits 2009-01-01 1
Total of all active and inactive participants 2009-01-01 29
Total participants 2009-01-01 29
Number of participants with account balances 2009-01-01 29

Measure	Date	Value
2013: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	29
Total of all active and inactive participants	2013-01-01	29
Total participants	2013-01-01	29
Number of participants with account balances	2013-01-01	29
2012: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	31
Total of all active and inactive participants	2012-01-01	31
Total participants	2012-01-01	31
Number of participants with account balances	2012-01-01	31
2011: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	27
Total of all active and inactive participants	2011-01-01	27
Total participants	2011-01-01	27
Number of participants with account balances	2011-01-01	27
2009: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	35
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	28
Number of retired or separated participants receiving benefits	2009-01-01	1
Total of all active and inactive participants	2009-01-01	29
Total participants	2009-01-01	29
Number of participants with account balances	2009-01-01	29

Financial Data on NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST

Measure	Date	Value
2013 : NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2013 401k financial data
Transfers to/from the plan	2013-12-31	$-532,522
Total income from all sources	2013-12-31	$5,176,817
Expenses. Total of all expenses incurred	2013-12-31	$158,655
Total plan assets at end of year	2013-12-31	$27,680,421
Total plan assets at beginning of year	2013-12-31	$23,194,781
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$550,463
Expenses. Other expenses not covered elsewhere	2013-12-31	$158,655
Other income received	2013-12-31	$3,675,085
Net income (gross income less expenses)	2013-12-31	$5,018,162
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$27,680,421
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$23,194,781
Assets. Value of participant loans	2013-12-31	$135,394
Total contributions received or receivable from employer(s)	2013-12-31	$951,269
2012 : NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2012 401k financial data
Transfers to/from the plan	2012-12-31	$271,734
Total income from all sources	2012-12-31	$3,197,658
Expenses. Total of all expenses incurred	2012-12-31	$117,058
Total plan assets at end of year	2012-12-31	$23,194,781
Total plan assets at beginning of year	2012-12-31	$19,842,447
Value of fidelity bond covering the plan	2012-12-31	$500,000
Total contributions received or receivable from participants	2012-12-31	$587,000
Expenses. Other expenses not covered elsewhere	2012-12-31	$117,058
Other income received	2012-12-31	$1,605,522
Net income (gross income less expenses)	2012-12-31	$3,080,600
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$23,194,781
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$19,842,447
Assets. Value of participant loans	2012-12-31	$164,779
Assets. Value of assets in partnership/joint-venture interests	2012-12-31	$422,902
Total contributions received or receivable from employer(s)	2012-12-31	$1,005,136
2011 : NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2011 401k financial data
Transfers to/from the plan	2011-12-31	$68,876
Total income from all sources	2011-12-31	$238,358
Expenses. Total of all expenses incurred	2011-12-31	$111,405
Total plan assets at end of year	2011-12-31	$19,842,447
Total plan assets at beginning of year	2011-12-31	$19,646,618
Value of fidelity bond covering the plan	2011-12-31	$500,000
Total contributions received or receivable from participants	2011-12-31	$517,000
Expenses. Other expenses not covered elsewhere	2011-12-31	$111,405
Contributions received from other sources (not participants or employers)	2011-12-31	$900
Other income received	2011-12-31	$-1,139,764
Net income (gross income less expenses)	2011-12-31	$126,953
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$19,842,447
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$19,646,618
Assets. Value of participant loans	2011-12-31	$144,783
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$379,803
Total contributions received or receivable from employer(s)	2011-12-31	$860,222
2010 : NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2010 401k financial data
Transfers to/from the plan	2010-12-31	$-1,586,276
Total income from all sources	2010-12-31	$3,437,043
Expenses. Total of all expenses incurred	2010-12-31	$521,464
Benefits paid (including direct rollovers)	2010-12-31	$443,305
Total plan assets at end of year	2010-12-31	$19,646,618
Total plan assets at beginning of year	2010-12-31	$18,317,315
Value of fidelity bond covering the plan	2010-12-31	$500,000
Total contributions received or receivable from participants	2010-12-31	$486,949
Expenses. Other expenses not covered elsewhere	2010-12-31	$78,159
Other income received	2010-12-31	$2,108,355
Net income (gross income less expenses)	2010-12-31	$2,915,579
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$19,646,618
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$18,317,315
Assets. Value of participant loans	2010-12-31	$50,614
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$468,773
Total contributions received or receivable from employer(s)	2010-12-31	$841,739

Form 5500 Responses for NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST

2013: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
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: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
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: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
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
2009: NORTHWEST SUBURBAN ANESTHESIOLOGIST LTD. EMPLOYEES' P/S PLAN AND TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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

Insurance Providers Used on plan

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

Policy contract number

09628

Policy instance

Insurance contract or identification number	09628
Number of Individuals Covered	1
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

70613829

Policy instance

Insurance contract or identification number	70613829
Number of Individuals Covered	1
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

70310478

Policy instance

Insurance contract or identification number	70310478
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

70613829

Policy instance

Insurance contract or identification number	70613829
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

14854 & 09628

Policy instance

Insurance contract or identification number	14854 & 09628
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

70613829

Policy instance

Insurance contract or identification number	70613829
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

70310478

Policy instance

Insurance contract or identification number	70310478
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

14854 & 09628

Policy instance

Insurance contract or identification number	14854 & 09628
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

14854 & 09628

Policy instance

Insurance contract or identification number	14854 & 09628
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

70613829

Policy instance

Insurance contract or identification number	70613829
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	DAVID GOYKHMAN

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

70310478

Policy instance

Insurance contract or identification number	70310478
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NORTHWEST SUBURBAN ANESTHESIOLOGIST
Employer identification number (EIN):	362777288
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)