401k Plan data: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT plan

WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 401k Plan overview

Plan Name	WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT
Plan identification number	509

WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION has sponsored the creation of one or more 401k plans.

Company Name: WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION

Employer identification number (EIN): 391268299

NAIC Classification: 524140

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
509 2013-01-01 CRAIG CAMPBELL
509 2012-01-01 CRAIG R.CAMPBELL
509 2011-01-01 WILLIAM C. BEISENSTEIN
509 2010-01-01 WILLIAM C. BEISENSTEIN
509 2009-01-01 WILLIAM C. BEISENSTEIN

Plan id#	Filing Submission Date	Name of Administrator
509	2013-01-01	CRAIG CAMPBELL
509	2012-01-01	CRAIG R.CAMPBELL
509	2011-01-01	WILLIAM C. BEISENSTEIN
509	2010-01-01	WILLIAM C. BEISENSTEIN
509	2009-01-01	WILLIAM C. BEISENSTEIN

Plan Statistics for WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT

401k plan membership statisitcs for WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT

Measure Date Value
2013: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 2013 401k membership
Total participants, beginning-of-year 2013-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
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 0
Total of all active and inactive participants 2013-01-01 0
2012: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 2012 401k membership
Total participants, beginning-of-year 2012-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 38
Total of all active and inactive participants 2012-01-01 38
2011: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 2011 401k membership
Total participants, beginning-of-year 2011-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 38
Total of all active and inactive participants 2011-01-01 38
2010: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 2010 401k membership
Total participants, beginning-of-year 2010-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 29
Total of all active and inactive participants 2010-01-01 29
2009: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 2009 401k membership
Total participants, beginning-of-year 2009-01-01 48
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 36
Total of all active and inactive participants 2009-01-01 36

Measure	Date	Value
2013: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 2013 401k membership
Total participants, beginning-of-year	2013-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
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	0
Total of all active and inactive participants	2013-01-01	0
2012: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 2012 401k membership
Total participants, beginning-of-year	2012-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	38
Total of all active and inactive participants	2012-01-01	38
2011: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 2011 401k membership
Total participants, beginning-of-year	2011-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	38
Total of all active and inactive participants	2011-01-01	38
2010: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 2010 401k membership
Total participants, beginning-of-year	2010-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	29
Total of all active and inactive participants	2010-01-01	29
2009: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 2009 401k membership
Total participants, beginning-of-year	2009-01-01	48
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	36
Total of all active and inactive participants	2009-01-01	36

Form 5500 Responses for WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT

2013: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 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	Yes
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 benefit arrangement – Insurance	Yes
2012: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 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 benefit arrangement – Insurance	Yes
2011: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 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 benefit arrangement – Insurance	Yes
2010: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: WPS TRAVEL ACCIDENT - EXECUTIVE MANAGEMENT 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 benefit arrangement – Insurance	Yes

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Company Name:	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION
Employer identification number (EIN):	391268299
NAIC Classification:	524140