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NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 401k Plan overview

Plan NameNORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN
Plan identification number 001

NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN Benefits

401k Plan TypeDefined 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 ANESTHESIA, P.A. has sponsored the creation of one or more 401k plans.

Company Name:NORTHWEST ANESTHESIA, P.A.
Employer identification number (EIN):411227535
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 ANESTHESIA, PA PROFIT SHARING 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012017-01-01RICHARD SKOOG2018-02-03
0012017-01-01RICHARD SKOOG2018-01-26
0012016-01-01RICHARD SKOOG
0012015-01-01RICHARD SKOOG
0012014-01-01DAVE ROTHSCHILLER
0012013-01-01DAVE ROTHSCHILLER
0012012-01-01DAVE ROTHSCHILLER
0012011-01-01CRAIG PELL
0012010-01-01BRIAN PONTO
0012009-01-01BRIAN PONTO BRIAN PONTO2010-10-14

Plan Statistics for NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN

401k plan membership statisitcs for NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN

Measure Date Value
2016: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01152
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0120
Total of all active and inactive participants2016-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0120
Number of participants with account balances2016-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01138
Total number of active participants reported on line 7a of the Form 55002015-01-01130
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0122
Total of all active and inactive participants2015-01-01152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01152
Number of participants with account balances2015-01-01142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-011
2014: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01145
Total number of active participants reported on line 7a of the Form 55002014-01-01114
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0124
Total of all active and inactive participants2014-01-01138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01138
Number of participants with account balances2014-01-01138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-015
2013: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01138
Total number of active participants reported on line 7a of the Form 55002013-01-01122
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0122
Total of all active and inactive participants2013-01-01144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-011
Total participants2013-01-01145
Number of participants with account balances2013-01-01135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-012
2012: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01133
Total number of active participants reported on line 7a of the Form 55002012-01-01118
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0120
Total of all active and inactive participants2012-01-01138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01138
Number of participants with account balances2012-01-01135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01133
Total number of active participants reported on line 7a of the Form 55002011-01-01115
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0118
Total of all active and inactive participants2011-01-01133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01133
Number of participants with account balances2011-01-01126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-011
2010: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01132
Total number of active participants reported on line 7a of the Form 55002010-01-01115
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0115
Total of all active and inactive participants2010-01-01130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-013
Total participants2010-01-01133
Number of participants with account balances2010-01-01131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-011
2009: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01127
Total number of active participants reported on line 7a of the Form 55002009-01-01116
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0115
Total of all active and inactive participants2009-01-01131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-011
Total participants2009-01-01132
Number of participants with account balances2009-01-01131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-017

Financial Data on NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN

Measure Date Value
2016 : NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$6,413
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$26,152
Total income from all sources (including contributions)2016-12-31$9,741,940
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$80,290,160
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$79,995,610
Value of total corrective distributions2016-12-31$115,727
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$2,377,253
Value of total assets at end of year2016-12-31$1,963,097
Value of total assets at beginning of year2016-12-31$72,531,056
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$178,823
Total interest from all sources2016-12-31$11,910
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$603,286
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2016-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$603,286
Administrative expenses professional fees incurred2016-12-31$95,519
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$1,089,165
Participant contributions at end of year2016-12-31$0
Participant contributions at beginning of year2016-12-31$337,996
Participant contributions at end of year2016-12-31$0
Participant contributions at beginning of year2016-12-31$5,245
Assets. Other investments not covered elsewhere at end of year2016-12-31$1,939,298
Assets. Other investments not covered elsewhere at beginning of year2016-12-31$12,628,753
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$56,353
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$6,331
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$19,176
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$6,413
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$26,152
Other income not declared elsewhere2016-12-31$1,846,807
Administrative expenses (other) incurred2016-12-31$9,975
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-70,548,220
Value of net assets at end of year (total assets less liabilities)2016-12-31$1,956,684
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$72,504,904
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$73,329
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$17,468
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$54,902,887
Interest on participant loans2016-12-31$11,910
Value of interest in common/collective trusts at end of year2016-12-31$0
Value of interest in common/collective trusts at beginning of year2016-12-31$3,822,664
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$4,837,488
Net investment gain or loss from common/collective trusts2016-12-31$65,196
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31Yes
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$1,231,735
Employer contributions (assets) at end of year2016-12-31$0
Employer contributions (assets) at beginning of year2016-12-31$814,335
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$79,995,610
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31OLSEN THIELEN & CO., LTD.
Accountancy firm EIN2016-12-31411360831
2015 : NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$26,152
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$21,699
Total income from all sources (including contributions)2015-12-31$3,973,255
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$6,408,302
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$6,225,000
Expenses. Certain deemed distributions of participant loans2015-12-31$14,359
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$4,679,860
Value of total assets at end of year2015-12-31$72,531,056
Value of total assets at beginning of year2015-12-31$74,961,650
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$168,943
Total interest from all sources2015-12-31$15,881
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$911,129
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$911,129
Administrative expenses professional fees incurred2015-12-31$26,231
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$2,040,902
Participant contributions at end of year2015-12-31$337,996
Participant contributions at beginning of year2015-12-31$342,805
Participant contributions at end of year2015-12-31$5,245
Participant contributions at beginning of year2015-12-31$5,500
Assets. Other investments not covered elsewhere at end of year2015-12-31$12,628,753
Assets. Other investments not covered elsewhere at beginning of year2015-12-31$14,349,943
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$4,876
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$19,176
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$17,502
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$26,152
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$21,699
Other income not declared elsewhere2015-12-31$-539,848
Administrative expenses (other) incurred2015-12-31$54,829
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-2,435,047
Value of net assets at end of year (total assets less liabilities)2015-12-31$72,504,904
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$74,939,951
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$87,883
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$54,902,887
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$55,661,169
Interest on participant loans2015-12-31$15,881
Value of interest in common/collective trusts at end of year2015-12-31$3,822,664
Value of interest in common/collective trusts at beginning of year2015-12-31$3,846,593
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-1,150,558
Net investment gain or loss from common/collective trusts2015-12-31$56,791
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31Yes
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$2,634,082
Employer contributions (assets) at end of year2015-12-31$814,335
Employer contributions (assets) at beginning of year2015-12-31$738,138
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$6,225,000
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31OLSEN THIELEN & CO., LTD.
Accountancy firm EIN2015-12-31411360831
2014 : NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$-7,010
Total unrealized appreciation/depreciation of assets2014-12-31$-7,010
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$21,699
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$4,372
Total income from all sources (including contributions)2014-12-31$8,967,614
Total loss/gain on sale of assets2014-12-31$-481
Total of all expenses incurred2014-12-31$9,341,166
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$9,186,044
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$4,476,947
Value of total assets at end of year2014-12-31$74,961,650
Value of total assets at beginning of year2014-12-31$75,317,875
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$155,122
Total interest from all sources2014-12-31$18,264
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$931,913
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$931,913
Administrative expenses professional fees incurred2014-12-31$9,800
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$1,984,940
Participant contributions at end of year2014-12-31$342,805
Participant contributions at beginning of year2014-12-31$321,170
Participant contributions at end of year2014-12-31$5,500
Participant contributions at beginning of year2014-12-31$3,053
Assets. Other investments not covered elsewhere at end of year2014-12-31$14,349,943
Assets. Other investments not covered elsewhere at beginning of year2014-12-31$15,136,579
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$1,386
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$17,502
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$25,523
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$21,699
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$4,372
Other income not declared elsewhere2014-12-31$775,038
Administrative expenses (other) incurred2014-12-31$69,066
Total non interest bearing cash at beginning of year2014-12-31$22,061
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-373,552
Value of net assets at end of year (total assets less liabilities)2014-12-31$74,939,951
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$75,313,503
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Assets. partnership/joint venture interests at beginning of year2014-12-31$80,660
Investment advisory and management fees2014-12-31$76,256
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$55,661,169
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$53,785,099
Interest on participant loans2014-12-31$16,214
Interest earned on other investments2014-12-31$2,050
Value of interest in common/collective trusts at end of year2014-12-31$3,846,593
Value of interest in common/collective trusts at beginning of year2014-12-31$5,226,649
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$2,706,481
Net investment gain or loss from common/collective trusts2014-12-31$66,462
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$2,490,621
Employer contributions (assets) at end of year2014-12-31$738,138
Employer contributions (assets) at beginning of year2014-12-31$717,081
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$9,186,044
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Aggregate proceeds on sale of assets2014-12-31$36,344
Aggregate carrying amount (costs) on sale of assets2014-12-31$36,825
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31OLSEN THIELEN & CO., LTD.
Accountancy firm EIN2014-12-31411360831
2013 : NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$-19,883
Total unrealized appreciation/depreciation of assets2013-12-31$-19,883
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$4,372
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$74,140
Total income from all sources (including contributions)2013-12-31$17,371,822
Total loss/gain on sale of assets2013-12-31$22,064
Total of all expenses incurred2013-12-31$2,597,216
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$2,488,758
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$4,484,225
Value of total assets at end of year2013-12-31$75,317,875
Value of total assets at beginning of year2013-12-31$60,613,037
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$108,458
Total interest from all sources2013-12-31$23,715
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$724,762
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$724,762
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$1,986,365
Participant contributions at end of year2013-12-31$321,170
Participant contributions at beginning of year2013-12-31$304,437
Participant contributions at end of year2013-12-31$3,053
Participant contributions at beginning of year2013-12-31$40,158
Assets. Other investments not covered elsewhere at end of year2013-12-31$15,136,579
Assets. Other investments not covered elsewhere at beginning of year2013-12-31$13,053,847
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$38,878
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$25,523
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$38,319
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$4,372
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$74,140
Other income not declared elsewhere2013-12-31$2,776,109
Administrative expenses (other) incurred2013-12-31$41,128
Total non interest bearing cash at end of year2013-12-31$22,061
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$14,774,606
Value of net assets at end of year (total assets less liabilities)2013-12-31$75,313,503
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$60,538,897
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Assets. partnership/joint venture interests at end of year2013-12-31$80,660
Assets. partnership/joint venture interests at beginning of year2013-12-31$125,360
Investment advisory and management fees2013-12-31$67,330
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$53,785,099
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$41,311,907
Interest on participant loans2013-12-31$15,798
Interest earned on other investments2013-12-31$7,917
Value of interest in common/collective trusts at end of year2013-12-31$5,226,649
Value of interest in common/collective trusts at beginning of year2013-12-31$4,989,365
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$9,281,143
Net investment gain or loss from common/collective trusts2013-12-31$79,687
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$2,458,982
Employer contributions (assets) at end of year2013-12-31$717,081
Employer contributions (assets) at beginning of year2013-12-31$749,644
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$2,488,758
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Aggregate proceeds on sale of assets2013-12-31$29,777
Aggregate carrying amount (costs) on sale of assets2013-12-31$7,713
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31OLSEN THIELEN & CO., LTD.
Accountancy firm EIN2013-12-31411360831
2012 : NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$26,893
Total unrealized appreciation/depreciation of assets2012-12-31$26,893
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$74,140
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$11,623,383
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$6,890,600
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$6,818,071
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$4,416,004
Value of total assets at end of year2012-12-31$60,613,037
Value of total assets at beginning of year2012-12-31$55,806,114
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$72,529
Total interest from all sources2012-12-31$21,282
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$846,341
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$846,341
Administrative expenses professional fees incurred2012-12-31$10,600
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$1,901,489
Participant contributions at end of year2012-12-31$304,437
Participant contributions at beginning of year2012-12-31$277,927
Participant contributions at end of year2012-12-31$40,158
Participant contributions at beginning of year2012-12-31$68,604
Assets. Other investments not covered elsewhere at end of year2012-12-31$13,053,847
Assets. Other investments not covered elsewhere at beginning of year2012-12-31$11,303,397
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$43,092
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$38,319
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$32,408
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$74,140
Other income not declared elsewhere2012-12-31$1,402,100
Administrative expenses (other) incurred2012-12-31$43,195
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$4,732,783
Value of net assets at end of year (total assets less liabilities)2012-12-31$60,538,897
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$55,806,114
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Assets. partnership/joint venture interests at end of year2012-12-31$125,360
Investment advisory and management fees2012-12-31$18,734
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$41,311,907
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$42,532,819
Interest on participant loans2012-12-31$14,280
Interest earned on other investments2012-12-31$7,002
Value of interest in common/collective trusts at end of year2012-12-31$4,989,365
Value of interest in common/collective trusts at beginning of year2012-12-31$866,698
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$4,840,903
Net investment gain or loss from common/collective trusts2012-12-31$69,860
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$2,471,423
Employer contributions (assets) at end of year2012-12-31$749,644
Employer contributions (assets) at beginning of year2012-12-31$724,261
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$6,818,071
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31OLSEN THIELEN & CO. LTD.
Accountancy firm EIN2012-12-31411360831
2011 : NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$3,574,992
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$1,065,109
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$1,029,188
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$4,158,164
Value of total assets at end of year2011-12-31$55,806,114
Value of total assets at beginning of year2011-12-31$53,296,231
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$35,921
Total interest from all sources2011-12-31$13,297
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$853,301
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$853,301
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$1,796,616
Participant contributions at end of year2011-12-31$277,927
Participant contributions at beginning of year2011-12-31$226,555
Participant contributions at end of year2011-12-31$68,604
Assets. Other investments not covered elsewhere at end of year2011-12-31$11,303,397
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$3,424,385
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$12,430
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$32,408
Other income not declared elsewhere2011-12-31$962,126
Administrative expenses (other) incurred2011-12-31$35,921
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$2,509,883
Value of net assets at end of year (total assets less liabilities)2011-12-31$55,806,114
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$53,296,231
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$42,532,819
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$46,162,391
Interest on participant loans2011-12-31$13,297
Value of interest in common/collective trusts at end of year2011-12-31$866,698
Value of interest in common/collective trusts at beginning of year2011-12-31$3,482,900
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-2,423,257
Net investment gain or loss from common/collective trusts2011-12-31$11,361
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$2,349,118
Employer contributions (assets) at end of year2011-12-31$724,261
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$1,029,188
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31OLSEN THEILELEN & CO. LTD
Accountancy firm EIN2011-12-31411360831
2010 : NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$10,346,165
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$1,659,365
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,587,438
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$4,459,594
Value of total assets at end of year2010-12-31$53,296,231
Value of total assets at beginning of year2010-12-31$44,609,431
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$71,927
Total interest from all sources2010-12-31$10,982
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$997,294
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$997,294
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$1,868,407
Participant contributions at end of year2010-12-31$226,555
Participant contributions at beginning of year2010-12-31$146,853
Assets. Other investments not covered elsewhere at end of year2010-12-31$3,424,385
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$3,110,703
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$209,051
Other income not declared elsewhere2010-12-31$313,681
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$8,686,800
Value of net assets at end of year (total assets less liabilities)2010-12-31$53,296,231
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$44,609,431
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$46,162,391
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$38,996,606
Interest on participant loans2010-12-31$10,982
Value of interest in common/collective trusts at end of year2010-12-31$3,482,900
Value of interest in common/collective trusts at beginning of year2010-12-31$2,355,269
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$4,538,361
Net investment gain or loss from common/collective trusts2010-12-31$26,253
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31Yes
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$2,382,136
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$1,587,438
Contract administrator fees2010-12-31$71,927
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31OLSEN THEILELEN & CO. LTD
Accountancy firm EIN2010-12-31411360831

Form 5500 Responses for NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN

2016: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: NORTHWEST ANESTHESIA, PA PROFIT SHARING 401K PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number3037025/340334
Policy instance 1
Insurance contract or identification number3037025/340334
Number of Individuals Covered0
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberI107689-OX
Policy instance 2
Insurance contract or identification numberI107689-OX
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED STATES FINANCIAL LIFE (National Association of Insurance Commissioners NAIC id number: 84530 )
Policy contract number0000356724
Policy instance 3
Insurance contract or identification number0000356724
Number of Individuals Covered0
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number3037025/3403344
Policy instance 1
Insurance contract or identification number3037025/3403344
Number of Individuals Covered2
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
UNITED STATES FINANCIAL LIFE (National Association of Insurance Commissioners NAIC id number: 84530 )
Policy contract number0000356724
Policy instance 2
Insurance contract or identification number0000356724
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Insurance broker organization code?3
Insurance broker name
ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberI107689-OX
Policy instance 3
Insurance contract or identification numberI107689-OX
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No

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