401k Plan data: TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN plan

TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number	501

TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

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

Company Name: TUPELO ANESTHESIA GROUP, P.A.

Employer identification number (EIN): 640503363

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2012-09-01 JOHN H DOUGLAS III JOHN H DOUGLAS III 2013-12-31
501 2011-09-01 JOHN H DOUGLAS III JOHN H DOUGLAS III 2013-01-04
501 2009-09-01 JOHN H DOUGLAS III JOHN H DOUGLAS III 2010-11-04

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2012-09-01	JOHN H DOUGLAS III	JOHN H DOUGLAS III	2013-12-31
501	2011-09-01	JOHN H DOUGLAS III	JOHN H DOUGLAS III	2013-01-04
501	2009-09-01	JOHN H DOUGLAS III	JOHN H DOUGLAS III	2010-11-04

Plan Statistics for TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN

401k plan membership statisitcs for TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN

Measure Date Value
2012: TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 31
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 0
Number of retired or separated participants receiving benefits 2012-09-01 0
Number of other retired or separated participants entitled to future benefits 2012-09-01 0
Total of all active and inactive participants 2012-09-01 0
2011: TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 39
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 31
Total of all active and inactive participants 2011-09-01 31
2009: TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-09-01 34
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 33
Number of retired or separated participants receiving benefits 2009-09-01 0
Number of other retired or separated participants entitled to future benefits 2009-09-01 0
Total of all active and inactive participants 2009-09-01 33
Total participants 2009-09-01 0

Measure	Date	Value
2012: TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	31
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	0
Number of retired or separated participants receiving benefits	2012-09-01	0
Number of other retired or separated participants entitled to future benefits	2012-09-01	0
Total of all active and inactive participants	2012-09-01	0
2011: TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	39
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	31
Total of all active and inactive participants	2011-09-01	31
2009: TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-09-01	34
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	33
Number of retired or separated participants receiving benefits	2009-09-01	0
Number of other retired or separated participants entitled to future benefits	2009-09-01	0
Total of all active and inactive participants	2009-09-01	33
Total participants	2009-09-01	0

Financial Data on TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN

Measure	Date	Value
2013 : TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-08-31	$0
Total income from all sources	2013-08-31	$210,057
Expenses. Total of all expenses incurred	2013-08-31	$241,300
Benefits paid (including direct rollovers)	2013-08-31	$240,100
Total plan assets at end of year	2013-08-31	$0
Total plan assets at beginning of year	2013-08-31	$31,243
Other income received	2013-08-31	$57
Net income (gross income less expenses)	2013-08-31	$-31,243
Net plan assets at end of year (total assets less liabilities)	2013-08-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2013-08-31	$31,243
Total contributions received or receivable from employer(s)	2013-08-31	$210,000
Expenses. Administrative service providers (salaries,fees and commissions)	2013-08-31	$1,200
2012 : TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2012 401k financial data
Total income from all sources	2012-08-31	$450,053
Expenses. Total of all expenses incurred	2012-08-31	$441,610
Benefits paid (including direct rollovers)	2012-08-31	$441,010
Total plan assets at end of year	2012-08-31	$31,243
Total plan assets at beginning of year	2012-08-31	$22,800
Other income received	2012-08-31	$53
Net income (gross income less expenses)	2012-08-31	$8,443
Net plan assets at end of year (total assets less liabilities)	2012-08-31	$31,243
Net plan assets at beginning of year (total assets less liabilities)	2012-08-31	$22,800
Total contributions received or receivable from employer(s)	2012-08-31	$450,000
Expenses. Administrative service providers (salaries,fees and commissions)	2012-08-31	$600
2011 : TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2011 401k financial data
Total income from all sources	2011-08-31	$394,423
Expenses. Total of all expenses incurred	2011-08-31	$480,257
Benefits paid (including direct rollovers)	2011-08-31	$479,657
Total plan assets at end of year	2011-08-31	$22,800
Total plan assets at beginning of year	2011-08-31	$108,634
Other income received	2011-08-31	$85
Net income (gross income less expenses)	2011-08-31	$-85,834
Net plan assets at end of year (total assets less liabilities)	2011-08-31	$22,800
Net plan assets at beginning of year (total assets less liabilities)	2011-08-31	$108,634
Total contributions received or receivable from employer(s)	2011-08-31	$394,338
Expenses. Administrative service providers (salaries,fees and commissions)	2011-08-31	$600

Form 5500 Responses for TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN

2012: TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Submission has been amended	No
2012-09-01	This submission is the final filing	Yes
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	No
2012-09-01	Plan funding arrangement – Trust	Yes
2012-09-01	Plan benefit arrangement - Trust	Yes
2011: TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Submission has been amended	No
2011-09-01	This submission is the final filing	No
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-09-01	Plan is a collectively bargained plan	No
2011-09-01	Plan funding arrangement – Trust	Yes
2011-09-01	Plan benefit arrangement - Trust	Yes
2009: TUPELO ANESTHESIA GROUP, P. A. EMPLOYEE WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Submission has been amended	No
2009-09-01	This submission is the final filing	No
2009-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-09-01	Plan is a collectively bargained plan	No
2009-09-01	Plan funding arrangement – Trust	Yes
2009-09-01	Plan benefit arrangement - Trust	Yes

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Company Name:	TUPELO ANESTHESIA GROUP, P.A.
Employer identification number (EIN):	640503363
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)