401k Plan data: STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN plan

STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN
Plan identification number	001

STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
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

STEVEN S. JACOBS, M.D., INC. has sponsored the creation of one or more 401k plans.

Company Name: STEVEN S. JACOBS, M.D., INC.

Employer identification number (EIN): 262089422

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

Additional information about STEVEN S. JACOBS, M.D., INC.

Jurisdiction of Incorporation: California Department of State

Incorporation Date: 2008-02-25

Company Identification Number: C3089208

Legal Registered Office Address: 2535 Alamo Country Circle

Alamo
United States of America (USA)
94507

More information about STEVEN S. JACOBS, M.D., INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 STEVEN S. JACOBS, M.D.
001 2014-01-01 STEVEN S. JACOBS, M.D.
001 2013-01-01 WEI GUO YU
001 2012-01-01 WEI GUO YU
001 2011-01-01 STEVEN S JACOBS MD 2012-08-19
001 2010-01-01 STEVEN S JACOBS MD 2011-06-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2015-01-01	STEVEN S. JACOBS, M.D.
001	2014-01-01	STEVEN S. JACOBS, M.D.
001	2013-01-01	WEI GUO YU
001	2012-01-01	WEI GUO YU
001	2011-01-01	STEVEN S JACOBS MD	2012-08-19
001	2010-01-01	STEVEN S JACOBS MD	2011-06-22

Plan Statistics for STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2015: STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1
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 0
Total of all active and inactive participants 2015-01-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 1
Number of participants with account balances 2015-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2
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 0
Total of all active and inactive participants 2014-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 2
Number of participants with account balances 2014-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2
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 0
Total of all active and inactive participants 2013-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 2
Number of participants with account balances 2013-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 3
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 0
Total of all active and inactive participants 2012-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 3
Number of participants with account balances 2012-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2015: STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1
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	0
Total of all active and inactive participants	2015-01-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	1
Number of participants with account balances	2015-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2
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	0
Total of all active and inactive participants	2014-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	2
Number of participants with account balances	2014-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2
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	0
Total of all active and inactive participants	2013-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	2
Number of participants with account balances	2013-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	3
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	0
Total of all active and inactive participants	2012-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	3
Number of participants with account balances	2012-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2015 : STEVEN S. JACOBS, M.D., INC. 401(K) 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	$-18,465
Expenses. Total of all expenses incurred	2015-12-31	$1,962,026
Benefits paid (including direct rollovers)	2015-12-31	$1,962,026
Total plan assets at end of year	2015-12-31	$2,466,300
Total plan assets at beginning of year	2015-12-31	$4,446,791
Total contributions received or receivable from participants	2015-12-31	$0
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	$-18,465
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-1,980,491
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$2,466,300
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$4,446,791
Total contributions received or receivable from employer(s)	2015-12-31	$0
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	$0
2014 : STEVEN S. JACOBS, M.D., INC. 401(K) 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	$358,900
Expenses. Total of all expenses incurred	2014-12-31	$0
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$4,446,791
Total plan assets at beginning of year	2014-12-31	$4,087,891
Total contributions received or receivable from participants	2014-12-31	$11,000
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	$243,900
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$358,900
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$4,446,791
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$4,087,891
Total contributions received or receivable from employer(s)	2014-12-31	$104,000
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	$0
2013 : STEVEN S. JACOBS, M.D., INC. 401(K) 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	$0
Total income from all sources	2013-12-31	$727,804
Expenses. Total of all expenses incurred	2013-12-31	$1,091,732
Benefits paid (including direct rollovers)	2013-12-31	$1,091,732
Total plan assets at end of year	2013-12-31	$4,087,891
Total plan assets at beginning of year	2013-12-31	$4,451,819
Total contributions received or receivable from participants	2013-12-31	$11,000
Other income received	2013-12-31	$614,804
Net income (gross income less expenses)	2013-12-31	$-363,928
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$4,087,891
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$4,451,819
Total contributions received or receivable from employer(s)	2013-12-31	$102,000
2012 : STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$1,561,933
Expenses. Total of all expenses incurred	2012-12-31	$0
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$4,451,819
Total plan assets at beginning of year	2012-12-31	$2,889,886
Total contributions received or receivable from participants	2012-12-31	$16,500
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$1,045,828
Other income received	2012-12-31	$349,605
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$1,561,933
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$4,451,819
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,889,886
Total contributions received or receivable from employer(s)	2012-12-31	$150,000
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0

Form 5500 Responses for STEVEN S. JACOBS, M.D., INC. 401(K) PROFIT SHARING PLAN

2015: STEVEN S. JACOBS, M.D., INC. 401(K) 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: STEVEN S. JACOBS, M.D., INC. 401(K) 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: STEVEN S. JACOBS, M.D., INC. 401(K) 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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: STEVEN S. JACOBS, M.D., INC. 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

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Company Name:	STEVEN S. JACOBS, M.D., INC.
Employer identification number (EIN):	262089422
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:	2008-02-25
Company Identification Number:	C3089208
Legal Registered Office Address:	2535 Alamo Country Circle Alamo United States of America (USA) 94507