401k Plan data: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN plan

ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 401k Plan overview

Plan Name	ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN
Plan identification number	002

ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
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

ARLINGTON SURGICAL ASSOCIATION, P.A. has sponsored the creation of one or more 401k plans.

Company Name: ARLINGTON SURGICAL ASSOCIATION, P.A.

Employer identification number (EIN): 751418826

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01 MANDY VALDEZ
002 2015-01-01 MANDY VALDEZ
002 2014-01-01 MANDY VALDEZ
002 2013-01-01 TERESA SULLIVAN
002 2012-01-01 H. PAUL STIEFEL, M.D. 2013-10-04
002 2011-01-01 H. PAUL STIEFEL, M.D.
002 2009-01-01 SCOTT E. ALLEN, M.D. SCOTT E. ALLEN, M.D. 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2016-01-01	MANDY VALDEZ
002	2015-01-01	MANDY VALDEZ
002	2014-01-01	MANDY VALDEZ
002	2013-01-01	TERESA SULLIVAN
002	2012-01-01	H. PAUL STIEFEL, M.D.	2013-10-04
002	2011-01-01	H. PAUL STIEFEL, M.D.
002	2009-01-01	SCOTT E. ALLEN, M.D.		SCOTT E. ALLEN, M.D.	2010-10-15

Plan Statistics for ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN

401k plan membership statisitcs for ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN

Measure Date Value
2016: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
2015: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 24
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 13
Total of all active and inactive participants 2015-01-01 37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 37
Number of participants with account balances 2015-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 24
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 21
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 8
Total of all active and inactive participants 2014-01-01 29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 29
Number of participants with account balances 2014-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 23
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 1
Total of all active and inactive participants 2013-01-01 24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 24
Number of participants with account balances 2013-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2011: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 25
Number of retired or separated participants receiving benefits 2011-01-01 1
Number of other retired or separated participants entitled to future benefits 2011-01-01 5
Total of all active and inactive participants 2011-01-01 31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 31
Number of participants with account balances 2011-01-01 31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 1
2009: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 19
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 4
Total of all active and inactive participants 2009-01-01 23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 23
Number of participants with account balances 2009-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2016: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
2015: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	24
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	13
Total of all active and inactive participants	2015-01-01	37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	37
Number of participants with account balances	2015-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	24
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	21
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	8
Total of all active and inactive participants	2014-01-01	29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	29
Number of participants with account balances	2014-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	23
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	1
Total of all active and inactive participants	2013-01-01	24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	24
Number of participants with account balances	2013-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2011: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	25
Number of retired or separated participants receiving benefits	2011-01-01	1
Number of other retired or separated participants entitled to future benefits	2011-01-01	5
Total of all active and inactive participants	2011-01-01	31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	31
Number of participants with account balances	2011-01-01	31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	1
2009: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	19
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	4
Total of all active and inactive participants	2009-01-01	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	23
Number of participants with account balances	2009-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN

Measure	Date	Value
2016 : ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan	2016-08-19	$0
Total plan liabilities at end of year	2016-08-19	$0
Total plan liabilities at beginning of year	2016-08-19	$0
Total income from all sources	2016-08-19	$300,968
Expenses. Total of all expenses incurred	2016-08-19	$6,474,911
Benefits paid (including direct rollovers)	2016-08-19	$6,391,514
Total plan assets at end of year	2016-08-19	$0
Total plan assets at beginning of year	2016-08-19	$6,173,943
Value of fidelity bond covering the plan	2016-08-19	$500,000
Total contributions received or receivable from participants	2016-08-19	$0
Expenses. Other expenses not covered elsewhere	2016-08-19	$0
Contributions received from other sources (not participants or employers)	2016-08-19	$0
Other income received	2016-08-19	$239,696
Noncash contributions received	2016-08-19	$0
Net income (gross income less expenses)	2016-08-19	$-6,173,943
Net plan assets at end of year (total assets less liabilities)	2016-08-19	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-08-19	$6,173,943
Assets. Value of participant loans	2016-08-19	$0
Total contributions received or receivable from employer(s)	2016-08-19	$61,272
Value of certain deemed distributions of participant loans	2016-08-19	$67,210
Value of corrective distributions	2016-08-19	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-08-19	$16,187
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-08-19	$0
2015 : ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$-141,164
Expenses. Total of all expenses incurred	2015-12-31	$146,905
Benefits paid (including direct rollovers)	2015-12-31	$133,461
Total plan assets at end of year	2015-12-31	$6,173,943
Total plan assets at beginning of year	2015-12-31	$6,462,012
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$103,564
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-305,397
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-288,069
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$6,173,943
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$6,462,012
Assets. Value of participant loans	2015-12-31	$66,576
Total contributions received or receivable from employer(s)	2015-12-31	$60,669
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$13,444
2014 : ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$751,444
Expenses. Total of all expenses incurred	2014-12-31	$34,621
Benefits paid (including direct rollovers)	2014-12-31	$1,250
Total plan assets at end of year	2014-12-31	$6,462,012
Total plan assets at beginning of year	2014-12-31	$5,745,189
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$142,469
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$371,274
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$716,823
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$6,462,012
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$5,745,189
Assets. Value of participant loans	2014-12-31	$69,454
Total contributions received or receivable from employer(s)	2014-12-31	$237,701
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$33,371
2013 : ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$3,831
Total income from all sources	2013-12-31	$804,225
Expenses. Total of all expenses incurred	2013-12-31	$52,578
Benefits paid (including direct rollovers)	2013-12-31	$49,306
Total plan assets at end of year	2013-12-31	$5,745,189
Total plan assets at beginning of year	2013-12-31	$4,997,373
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$115,256
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$443,553
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$751,647
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$5,745,189
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$4,993,542
Assets. Value of participant loans	2013-12-31	$42,314
Total contributions received or receivable from employer(s)	2013-12-31	$245,416
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$3,272
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2011 : ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2011 401k financial data
Total plan liabilities at end of year	2011-12-31	$21,503
Total plan liabilities at beginning of year	2011-12-31	$5,820
Total income from all sources	2011-12-31	$333,150
Expenses. Total of all expenses incurred	2011-12-31	$49,120
Benefits paid (including direct rollovers)	2011-12-31	$16,000
Total plan assets at end of year	2011-12-31	$4,634,198
Total plan assets at beginning of year	2011-12-31	$4,334,485
Value of fidelity bond covering the plan	2011-12-31	$500,000
Total contributions received or receivable from participants	2011-12-31	$122,359
Expenses. Other expenses not covered elsewhere	2011-12-31	$11,952
Other income received	2011-12-31	$-32,862
Net income (gross income less expenses)	2011-12-31	$284,030
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$4,612,695
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$4,328,665
Assets. Value of participant loans	2011-12-31	$28,813
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2011-12-31	$35,398
Total contributions received or receivable from employer(s)	2011-12-31	$243,653
Value of certain deemed distributions of participant loans	2011-12-31	$21,168
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$5,820
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$818,426
Expenses. Total of all expenses incurred	2010-12-31	$22,366
Benefits paid (including direct rollovers)	2010-12-31	$5,403
Total plan assets at end of year	2010-12-31	$4,334,485
Total plan assets at beginning of year	2010-12-31	$3,532,605
Value of fidelity bond covering the plan	2010-12-31	$500,000
Total contributions received or receivable from participants	2010-12-31	$137,911
Other income received	2010-12-31	$437,138
Net income (gross income less expenses)	2010-12-31	$796,060
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$4,328,665
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$3,532,605
Assets. Value of participant loans	2010-12-31	$44,687
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$32
Total contributions received or receivable from employer(s)	2010-12-31	$243,377
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$16,963
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : ARLINGTON SURGICAL ASSOCIATION EMPLOYEES 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 ARLINGTON SURGICAL ASSOCIATION EMPLOYEES PROFIT SHARING PLAN

2016: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES 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	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES 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: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES 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: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES 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
2011: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES 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
2009: ARLINGTON SURGICAL ASSOCIATION EMPLOYEES 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

METLIFE INVESTORS (National Association of Insurance Commissioners NAIC id number: 80950 )

Policy contract number

918100

Policy instance

Insurance contract or identification number	918100
Number of Individuals Covered	0
Insurance policy start date	2016-01-01
Insurance policy end date	2016-04-27
Total amount of commissions paid to insurance broker	USD $0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

918100

Policy instance

Insurance contract or identification number	918100
Number of Individuals Covered	15
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

918100

Policy instance

Insurance contract or identification number	918100
Number of Individuals Covered	15
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

918100

Policy instance

Insurance contract or identification number	918100
Number of Individuals Covered	15
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $58
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $58
Amount paid for insurance broker fees	0
Insurance broker name	PROTER/NECHEMIA JEROME

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

918100

Policy instance

Insurance contract or identification number	918100
Number of Individuals Covered	25
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,583
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

918100

Policy instance

Insurance contract or identification number	918100
Number of Individuals Covered	25
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $8,375
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

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Company Name:	ARLINGTON SURGICAL ASSOCIATION, P.A.
Employer identification number (EIN):	751418826
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)