401k Plan data: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN plan

MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN
Plan identification number	001

MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 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.
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

MERCY ANESTHESIOLOGISTS, INC. has sponsored the creation of one or more 401k plans.

Company Name: MERCY ANESTHESIOLOGISTS, INC.

Employer identification number (EIN): 310791535

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

Additional information about MERCY ANESTHESIOLOGISTS, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1970-06-26

Company Identification Number: 399171

Legal Registered Office Address: 2790 KILKENNY DR.
-
SPRINGFIELD
United States of America (USA)
45503

More information about MERCY ANESTHESIOLOGISTS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01 THALES N. PAVLATOS 2024-10-10
001 2023-01-01 GEORGE BOSTON 2024-12-13
001 2022-01-01 THALES N. PAVLATOS 2023-09-29
001 2021-01-01 THALES N. PAVLATOS 2022-06-10
001 2020-01-01 THALES N. PAVLATOS 2021-09-28
001 2019-01-01 THALES N. PAVLATOS 2020-09-03
001 2018-01-01 THALES N. PAVLATOS 2019-10-02
001 2017-01-01 THALES N. PAVLATOS
001 2016-01-01 THALES N. PAVLATOS
001 2015-01-01 THALES N. PAVLATOS
001 2014-01-01 THALES N. PAVLATOS
001 2013-01-01 THALES N. PAVLATOS
001 2012-01-01 THALES N. PAVLATOS
001 2011-01-01 THALES N. PAVLATOS
001 2010-01-01 THALES N. PAVLATOS
001 2009-01-01 THALES N. PAVLATOS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2023-01-01	THALES N. PAVLATOS	2024-10-10
001	2023-01-01	GEORGE BOSTON	2024-12-13
001	2022-01-01	THALES N. PAVLATOS	2023-09-29
001	2021-01-01	THALES N. PAVLATOS	2022-06-10
001	2020-01-01	THALES N. PAVLATOS	2021-09-28
001	2019-01-01	THALES N. PAVLATOS	2020-09-03
001	2018-01-01	THALES N. PAVLATOS	2019-10-02
001	2017-01-01	THALES N. PAVLATOS
001	2016-01-01	THALES N. PAVLATOS
001	2015-01-01	THALES N. PAVLATOS
001	2014-01-01	THALES N. PAVLATOS
001	2013-01-01	THALES N. PAVLATOS
001	2012-01-01	THALES N. PAVLATOS
001	2011-01-01	THALES N. PAVLATOS
001	2010-01-01	THALES N. PAVLATOS
001	2009-01-01	THALES N. PAVLATOS

Financial Data on MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN

Measure	Date	Value
2025 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2025 401k financial data
Total expenses incurred by plan in this plan year	2025-09-12	23613
Net assets as of the end of the plan year	2025-09-12	13869058
Total assets as of the beginning of the plan year	2025-09-12	11406886
Value of plan covered by a fidelity bond	2025-09-12	500000
Participant contributions to plan in this plan year	2025-09-12	176573
Other income to plan in this plan year	2025-09-12	2241002
Plan net income in this plan year	2025-09-12	2462172
Net assets as of the end of the plan year	2025-09-12	13869058
Net assets as of the beginning of the plan year	2025-09-12	11406886
Employer contributions to plan in this plan year	2025-09-12	68210
Expensese paid to adminstrative service provicers from plan in this plan year	2025-09-12	23063
2024 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2024 401k financial data
Total expenses incurred by plan in this plan year	2024-12-13	857659
Net assets as of the end of the plan year	2024-12-13	11406886
Total assets as of the beginning of the plan year	2024-12-13	9714987
Value of plan covered by a fidelity bond	2024-12-13	500000
Participant contributions to plan in this plan year	2024-12-13	204887
Other income to plan in this plan year	2024-12-13	2005689
Plan net income in this plan year	2024-12-13	1691899
Net assets as of the end of the plan year	2024-12-13	11406886
Net assets as of the beginning of the plan year	2024-12-13	9714987
Employer contributions to plan in this plan year	2024-12-13	338982
Expensese paid to adminstrative service provicers from plan in this plan year	2024-12-13	26124
2022 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2022 401k financial data
Total expenses incurred by plan in this plan year	2022-06-10	4558215
Net assets as of the end of the plan year	2022-06-10	11279921
Total assets as of the beginning of the plan year	2022-06-10	13328654
Value of plan covered by a fidelity bond	2022-06-10	500000
Participant contributions to plan in this plan year	2022-06-10	175982
Other contributions to plan in this plan year	2022-06-10	582218
Other income to plan in this plan year	2022-06-10	1500903
Plan net income in this plan year	2022-06-10	-2048733
Net assets as of the end of the plan year	2022-06-10	11279921
Net assets as of the beginning of the plan year	2022-06-10	13328654
Employer contributions to plan in this plan year	2022-06-10	250379
Expensese paid to adminstrative service provicers from plan in this plan year	2022-06-10	19056
2017 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$3,177,669
Expenses. Total of all expenses incurred	2017-12-31	$196,300
Benefits paid (including direct rollovers)	2017-12-31	$161,882
Total plan assets at end of year	2017-12-31	$15,565,028
Total plan assets at beginning of year	2017-12-31	$12,583,659
Value of fidelity bond covering the plan	2017-12-31	$650,000
Total contributions received or receivable from participants	2017-12-31	$169,430
Other income received	2017-12-31	$2,798,513
Net income (gross income less expenses)	2017-12-31	$2,981,369
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$15,565,028
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$12,583,659
Assets. Value of real-estate (other than employer real property)	2017-12-31	$0
Total contributions received or receivable from employer(s)	2017-12-31	$209,726
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$34,418
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$1,240,112
Expenses. Total of all expenses incurred	2016-12-31	$84,552
Benefits paid (including direct rollovers)	2016-12-31	$51,345
Total plan assets at end of year	2016-12-31	$12,583,659
Total plan assets at beginning of year	2016-12-31	$11,428,099
Value of fidelity bond covering the plan	2016-12-31	$650,000
Total contributions received or receivable from participants	2016-12-31	$145,316
Other income received	2016-12-31	$888,977
Net income (gross income less expenses)	2016-12-31	$1,155,560
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$12,583,659
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$11,428,099
Assets. Value of real-estate (other than employer real property)	2016-12-31	$636,588
Total contributions received or receivable from employer(s)	2016-12-31	$205,819
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$33,207
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$214,891
Expenses. Total of all expenses incurred	2015-12-31	$40,949
Benefits paid (including direct rollovers)	2015-12-31	$7,719
Total plan assets at end of year	2015-12-31	$11,428,099
Total plan assets at beginning of year	2015-12-31	$11,254,157
Value of fidelity bond covering the plan	2015-12-31	$650,000
Total contributions received or receivable from participants	2015-12-31	$149,931
Contributions received from other sources (not participants or employers)	2015-12-31	$10,093
Other income received	2015-12-31	$-158,644
Net income (gross income less expenses)	2015-12-31	$173,942
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$11,428,099
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$11,254,157
Assets. Value of real-estate (other than employer real property)	2015-12-31	$636,588
Total contributions received or receivable from employer(s)	2015-12-31	$213,511
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$33,230
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$1,043,701
Expenses. Total of all expenses incurred	2014-12-31	$25,395
Total plan assets at end of year	2014-12-31	$11,254,157
Total plan assets at beginning of year	2014-12-31	$10,235,851
Value of fidelity bond covering the plan	2014-12-31	$650,000
Total contributions received or receivable from participants	2014-12-31	$149,278
Other income received	2014-12-31	$678,740
Net income (gross income less expenses)	2014-12-31	$1,018,306
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$11,254,157
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$10,235,851
Assets. Value of real-estate (other than employer real property)	2014-12-31	$636,588
Total contributions received or receivable from employer(s)	2014-12-31	$215,683
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$25,395
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$1,863,781
Expenses. Total of all expenses incurred	2013-12-31	$278,513
Benefits paid (including direct rollovers)	2013-12-31	$253,757
Total plan assets at end of year	2013-12-31	$10,235,851
Total plan assets at beginning of year	2013-12-31	$8,650,583
Value of fidelity bond covering the plan	2013-12-31	$650,000
Total contributions received or receivable from participants	2013-12-31	$140,315
Contributions received from other sources (not participants or employers)	2013-12-31	$42,722
Other income received	2013-12-31	$1,437,126
Net income (gross income less expenses)	2013-12-31	$1,585,268
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$10,235,851
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$8,650,583
Assets. Value of real-estate (other than employer real property)	2013-12-31	$636,588
Total contributions received or receivable from employer(s)	2013-12-31	$243,618
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$24,756
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$1,249,839
Expenses. Total of all expenses incurred	2012-12-31	$55,143
Benefits paid (including direct rollovers)	2012-12-31	$36,632
Total plan assets at end of year	2012-12-31	$8,650,583
Total plan assets at beginning of year	2012-12-31	$7,455,887
Value of fidelity bond covering the plan	2012-12-31	$650,000
Total contributions received or receivable from participants	2012-12-31	$117,016
Other income received	2012-12-31	$904,439
Net income (gross income less expenses)	2012-12-31	$1,194,696
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$8,650,583
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$7,455,887
Assets. Value of real-estate (other than employer real property)	2012-12-31	$636,588
Total contributions received or receivable from employer(s)	2012-12-31	$228,384
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$18,511
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$135,471
Expenses. Total of all expenses incurred	2011-12-31	$42,694
Benefits paid (including direct rollovers)	2011-12-31	$23,761
Total plan assets at end of year	2011-12-31	$7,455,887
Total plan assets at beginning of year	2011-12-31	$7,363,110
Value of fidelity bond covering the plan	2011-12-31	$650,000
Total contributions received or receivable from participants	2011-12-31	$116,340
Other income received	2011-12-31	$-200,794
Net income (gross income less expenses)	2011-12-31	$92,777
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$7,455,887
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$7,363,110
Assets. Value of real-estate (other than employer real property)	2011-12-31	$636,588
Total contributions received or receivable from employer(s)	2011-12-31	$219,925
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$18,933
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$1,263,833
Expenses. Total of all expenses incurred	2010-12-31	$18,370
Total plan assets at end of year	2010-12-31	$7,363,110
Total plan assets at beginning of year	2010-12-31	$6,117,647
Value of fidelity bond covering the plan	2010-12-31	$650,000
Total contributions received or receivable from participants	2010-12-31	$166,098
Other income received	2010-12-31	$839,355
Net income (gross income less expenses)	2010-12-31	$1,245,463
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$7,363,110
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$6,117,647
Assets. Value of real-estate (other than employer real property)	2010-12-31	$636,588
Total contributions received or receivable from employer(s)	2010-12-31	$258,380
Value of certain deemed distributions of participant loans	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$18,370
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN

2017: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
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 funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 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	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 funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – 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: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING 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 funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING 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 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

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	E1531079
Policy instance	2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	E1343089
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	E1531079
Policy instance	2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	E1343089
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	E1531079
Policy instance	2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	E1343089
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	E1531079
Policy instance	2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	E1343089
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	E1343089
Policy instance	1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 79065 )
Policy contract number	1050005456
Policy instance	1
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 79065 )
Policy contract number	1050005456
Policy instance	1

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Company Name:	MERCY ANESTHESIOLOGISTS, INC.
Employer identification number (EIN):	310791535
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1970-06-26
Company Identification Number:	399171
Legal Registered Office Address:	2790 KILKENNY DR. - SPRINGFIELD United States of America (USA) 45503