401k Plan data: CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN plan

CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN
Plan identification number	001

CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
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

CENTER FOR PAIN RELIEF TRI-STATE, PLLC has sponsored the creation of one or more 401k plans.

Company Name: CENTER FOR PAIN RELIEF TRI-STATE, PLLC

Employer identification number (EIN): 203735494

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 DAVID CARAWAY 2015-10-14
001 2013-01-01 DAVID CARAWAY 2014-09-22
001 2012-01-01 DAVID CARAWAY
001 2011-01-01 DAVID CARAWAY
001 2009-01-01 DAVID CARAWAY
001 2009-01-01 DAVID CARAWAY
001 2009-01-01 DAVID CARAWAY
001 2009-01-01 DAVID CARAWAY

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2014-01-01	DAVID CARAWAY	2015-10-14
001	2013-01-01	DAVID CARAWAY	2014-09-22
001	2012-01-01	DAVID CARAWAY
001	2011-01-01	DAVID CARAWAY
001	2009-01-01	DAVID CARAWAY
001	2009-01-01	DAVID CARAWAY
001	2009-01-01	DAVID CARAWAY
001	2009-01-01	DAVID CARAWAY

Plan Statistics for CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN

Measure Date Value
2012: CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 5
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 2
Total of all active and inactive participants 2012-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 7
Number of participants with account balances 2012-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 2
Total of all active and inactive participants 2011-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 6
Number of participants with account balances 2011-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 5
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 1
Total of all active and inactive participants 2009-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 6
Number of participants with account balances 2009-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2012: CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	5
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	2
Total of all active and inactive participants	2012-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	7
Number of participants with account balances	2012-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	2
Total of all active and inactive participants	2011-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	6
Number of participants with account balances	2011-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	5
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	1
Total of all active and inactive participants	2009-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	6
Number of participants with account balances	2009-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2012 : CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$161,311
Expenses. Total of all expenses incurred	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$741,509
Total plan assets at beginning of year	2012-12-31	$580,198
Value of fidelity bond covering the plan	2012-12-31	$75,000
Total contributions received or receivable from participants	2012-12-31	$37,873
Other income received	2012-12-31	$72,554
Net income (gross income less expenses)	2012-12-31	$161,311
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$741,509
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$580,198
Total contributions received or receivable from employer(s)	2012-12-31	$50,884
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$36,990
Expenses. Total of all expenses incurred	2011-12-31	$1,914
Benefits paid (including direct rollovers)	2011-12-31	$1,914
Total plan assets at end of year	2011-12-31	$580,198
Total plan assets at beginning of year	2011-12-31	$545,122
Value of fidelity bond covering the plan	2011-12-31	$75,000
Total contributions received or receivable from participants	2011-12-31	$32,308
Other income received	2011-12-31	$-39,080
Net income (gross income less expenses)	2011-12-31	$35,076
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$580,198
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$545,122
Total contributions received or receivable from employer(s)	2011-12-31	$43,762
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$273,468
Expenses. Total of all expenses incurred	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$545,122
Total plan assets at beginning of year	2010-12-31	$271,654
Total contributions received or receivable from participants	2010-12-31	$37,500
Contributions received from other sources (not participants or employers)	2010-12-31	$124,069
Other income received	2010-12-31	$184,456
Net income (gross income less expenses)	2010-12-31	$273,468
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$545,122
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$271,654
Total contributions received or receivable from employer(s)	2010-12-31	$51,512
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) 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 CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN

2012: CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: CENTER FOR PAIN RELIEF TRI-STATE, PLLC 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	CENTER FOR PAIN RELIEF TRI-STATE, PLLC
Employer identification number (EIN):	203735494
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)