401k Plan data: CAPITAL EYES 401(K) PROFIT SHARING PLAN plan

CAPITAL EYES 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	CAPITAL EYES 401(K) PROFIT SHARING PLAN
Plan identification number	003

CAPITAL EYES 401(K) 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
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.
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

CAPITAL EYES OPHTHALMOLOGY, INC. has sponsored the creation of one or more 401k plans.

Company Name: CAPITAL EYES OPHTHALMOLOGY, INC.

Employer identification number (EIN): 341901715

NAIC Classification: 621112
NAIC Description: Offices of Physicians, Mental Health Specialists

Additional information about CAPITAL EYES OPHTHALMOLOGY, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division

Incorporation Date: 1999-06-17

Company Identification Number: 1083268

Legal Registered Office Address: 1301 EAST NINTH STREET
SUITE 3500
CLEVELAND
United States of America (USA)
44114

More information about CAPITAL EYES OPHTHALMOLOGY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAPITAL EYES 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2016-01-01
003 2015-01-01
003 2014-01-01 MIRFEE UNGIER 2015-10-06
003 2013-01-01 KIMFLETT
003 2012-01-01 JAYSEN MERCER
003 2011-01-01 KIMFLETT

Plan Statistics for CAPITAL EYES 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for CAPITAL EYES 401(K) PROFIT SHARING PLAN

Measure Date Value
2013: CAPITAL EYES 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 5
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 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 5
Number of participants with account balances 2013-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: CAPITAL EYES 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 5
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 0
Total of all active and inactive participants 2012-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 5
Number of participants with account balances 2012-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: CAPITAL EYES 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 5
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 0
Total of all active and inactive participants 2011-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 5
Number of participants with account balances 2011-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2013: CAPITAL EYES 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	5
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	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	5
Number of participants with account balances	2013-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: CAPITAL EYES 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	5
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	0
Total of all active and inactive participants	2012-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	5
Number of participants with account balances	2012-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: CAPITAL EYES 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	5
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	0
Total of all active and inactive participants	2011-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	5
Number of participants with account balances	2011-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on CAPITAL EYES 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2013 : CAPITAL EYES 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$83,594
Expenses. Total of all expenses incurred	2013-12-31	$5,491
Benefits paid (including direct rollovers)	2013-12-31	$5,491
Total plan assets at end of year	2013-12-31	$303,653
Total plan assets at beginning of year	2013-12-31	$225,550
Value of fidelity bond covering the plan	2013-12-31	$25,000
Total contributions received or receivable from participants	2013-12-31	$30,524
Other income received	2013-12-31	$10,025
Net income (gross income less expenses)	2013-12-31	$78,103
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$303,653
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$225,550
Total contributions received or receivable from employer(s)	2013-12-31	$43,045
2012 : CAPITAL EYES 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$73,589
Expenses. Total of all expenses incurred	2012-12-31	$1,120
Benefits paid (including direct rollovers)	2012-12-31	$1,120
Total plan assets at end of year	2012-12-31	$225,550
Total plan assets at beginning of year	2012-12-31	$153,081
Total contributions received or receivable from participants	2012-12-31	$24,865
Other income received	2012-12-31	$8,521
Net income (gross income less expenses)	2012-12-31	$72,469
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$225,550
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$153,081
Total contributions received or receivable from employer(s)	2012-12-31	$40,203
2011 : CAPITAL EYES 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$153,081
Expenses. Total of all expenses incurred	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$153,081
Total plan assets at beginning of year	2011-12-31	$0
Total contributions received or receivable from participants	2011-12-31	$29,823
Contributions received from other sources (not participants or employers)	2011-12-31	$84,919
Other income received	2011-12-31	$-1,273
Net income (gross income less expenses)	2011-12-31	$153,081
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$153,081
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$39,612

Form 5500 Responses for CAPITAL EYES 401(K) PROFIT SHARING PLAN

2013: CAPITAL EYES 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: CAPITAL EYES 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: CAPITAL EYES 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
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

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Company Name:	CAPITAL EYES OPHTHALMOLOGY, INC.
Employer identification number (EIN):	341901715
NAIC Classification:	621112
NAIC Description:	Offices of Physicians, Mental Health Specialists

Jurisdiction of Incorporation:	Ohio Secretary of State Business Services Division
Incorporation Date:	1999-06-17
Company Identification Number:	1083268
Legal Registered Office Address:	1301 EAST NINTH STREET SUITE 3500 CLEVELAND United States of America (USA) 44114

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
003	2016-01-01
003	2015-01-01
003	2014-01-01	MIRFEE UNGIER	2015-10-06
003	2013-01-01	KIMFLETT
003	2012-01-01	JAYSEN MERCER
003	2011-01-01	KIMFLETT