401k Plan data: BRYAN PHYSICIAN NETWORK

BRYAN PHYSICIAN NETWORK - VISION PLAN 401k Plan overview

Plan Name	BRYAN PHYSICIAN NETWORK - VISION PLAN
Plan identification number	504

BRYAN PHYSICIAN NETWORK - VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision

401k Sponsoring company profile

BRYAN PHYSICIAN NETWORK has sponsored the creation of one or more 401k plans.

Company Name: BRYAN PHYSICIAN NETWORK

Employer identification number (EIN): 201357375

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRYAN PHYSICIAN NETWORK - VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2014-01-01 PAULA FANKHAUSER
504 2014-01-01 PAULA FANKHAUSER
504 2013-01-01 PAULA FANKHAUSER PAULA FANKHAUSER 2014-10-10
504 2012-01-01 REBECCA OLSON REBECCA OLSON 2013-10-15
504 2011-01-01 REBECCA OLSON
504 2009-01-01 SANDRA TAYLOR

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
504	2014-01-01	PAULA FANKHAUSER
504	2014-01-01	PAULA FANKHAUSER
504	2013-01-01	PAULA FANKHAUSER	PAULA FANKHAUSER	2014-10-10
504	2012-01-01	REBECCA OLSON	REBECCA OLSON	2013-10-15
504	2011-01-01	REBECCA OLSON
504	2009-01-01	SANDRA TAYLOR

Plan Statistics for BRYAN PHYSICIAN NETWORK - VISION PLAN

401k plan membership statisitcs for BRYAN PHYSICIAN NETWORK - VISION PLAN

Measure Date Value
2014: BRYAN PHYSICIAN NETWORK - VISION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 166
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 109
Total of all active and inactive participants 2014-01-01 109
Total participants 2014-01-01 109
2013: BRYAN PHYSICIAN NETWORK - VISION PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 166
Total of all active and inactive participants 2013-01-01 166
Total participants 2013-01-01 166
2012: BRYAN PHYSICIAN NETWORK - VISION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 159
Total of all active and inactive participants 2012-01-01 159
Total participants 2012-01-01 159
2011: BRYAN PHYSICIAN NETWORK - VISION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 159
Total of all active and inactive participants 2011-01-01 159
Total participants 2011-01-01 159
2009: BRYAN PHYSICIAN NETWORK - VISION PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 149
Total of all active and inactive participants 2009-01-01 149
Total participants 2009-01-01 149

Measure	Date	Value
2014: BRYAN PHYSICIAN NETWORK - VISION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	166
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	109
Total of all active and inactive participants	2014-01-01	109
Total participants	2014-01-01	109
2013: BRYAN PHYSICIAN NETWORK - VISION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	166
Total of all active and inactive participants	2013-01-01	166
Total participants	2013-01-01	166
2012: BRYAN PHYSICIAN NETWORK - VISION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	159
Total of all active and inactive participants	2012-01-01	159
Total participants	2012-01-01	159
2011: BRYAN PHYSICIAN NETWORK - VISION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	159
Total of all active and inactive participants	2011-01-01	159
Total participants	2011-01-01	159
2009: BRYAN PHYSICIAN NETWORK - VISION PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	149
Total of all active and inactive participants	2009-01-01	149
Total participants	2009-01-01	149

Form 5500 Responses for BRYAN PHYSICIAN NETWORK - VISION PLAN

2014: BRYAN PHYSICIAN NETWORK - VISION PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: BRYAN PHYSICIAN NETWORK - VISION PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
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: BRYAN PHYSICIAN NETWORK - VISION PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
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 – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: BRYAN PHYSICIAN NETWORK - VISION 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 – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: BRYAN PHYSICIAN NETWORK - VISION PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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 – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-27648

Policy instance

Insurance contract or identification number	010-27648
Number of Individuals Covered	240
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $671
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $24,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $671
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3
Insurance broker name	BETTENHAUSEN INSURANCE SERVICES LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-027648

Policy instance

Insurance contract or identification number	010-027648
Number of Individuals Covered	365
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $780
Total amount of fees paid to insurance company	USD $290
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $33,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $780
Amount paid for insurance broker fees	290
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3
Insurance broker name	BETTENHAUSEN INSURANCE SERVICES LLC

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010-027648

Policy instance

Insurance contract or identification number	010-027648
Number of Individuals Covered	349
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $749
Total amount of fees paid to insurance company	USD $256
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $33,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $749
Amount paid for insurance broker fees	256
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3
Insurance broker name	BETTENHAUSEN, ROBERT N.

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010027648

Policy instance

Insurance contract or identification number	010027648
Number of Individuals Covered	349
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $747
Total amount of fees paid to insurance company	USD $228
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

010027648

Policy instance

Insurance contract or identification number	010027648
Number of Individuals Covered	319
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,228
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,228
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SALES AND SERVICE
Insurance broker organization code?	3
Insurance broker name	ROBERT N. BETTENHAUSEN

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Company Name:	BRYAN PHYSICIAN NETWORK
Employer identification number (EIN):	201357375
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)