401k Plan data: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN plan

DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 401k Plan overview

Plan Name	DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN
Plan identification number	001

DAVID J. PALMER, M.D., S.C. 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
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

DAVID J. PALMER, M.D., S.C. has sponsored the creation of one or more 401k plans.

Company Name: DAVID J. PALMER, M.D., S.C.

Employer identification number (EIN): 363503946

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 DAVID PALMER DAVID PALMER 2017-05-18
001 2015-01-01 DAVID PALMER DAVID PALMER 2016-05-04
001 2014-01-01 DAVID PALMER DAVID PALMER 2015-09-22
001 2013-01-01 DAVID PALMER DAVID PALMER 2014-09-14
001 2012-01-01 DAVID PALMER DAVID PALMER 2013-09-15
001 2011-01-01 DAVID PALMER DAVID PALMER 2012-09-09
001 2010-01-01 DAVID PALMER DAVID PALMER 2011-08-25
001 2009-01-01 DAVID J. PALMER

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	DAVID PALMER	DAVID PALMER	2017-05-18
001	2015-01-01	DAVID PALMER	DAVID PALMER	2016-05-04
001	2014-01-01	DAVID PALMER	DAVID PALMER	2015-09-22
001	2013-01-01	DAVID PALMER	DAVID PALMER	2014-09-14
001	2012-01-01	DAVID PALMER	DAVID PALMER	2013-09-15
001	2011-01-01	DAVID PALMER	DAVID PALMER	2012-09-09
001	2010-01-01	DAVID PALMER	DAVID PALMER	2011-08-25
001	2009-01-01	DAVID J. PALMER

Plan Statistics for DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN

401k plan membership statisitcs for DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN

Measure Date Value
2016: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 6
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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 6
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 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 6
Number of participants with account balances 2015-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 4
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 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 4
Number of participants with account balances 2014-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1
2013: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 6
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 1
Total of all active and inactive participants 2013-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 3
Number of participants with account balances 2013-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 3
2012: DAVID J. PALMER, M.D., S.C. 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 4
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 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 4
Number of participants with account balances 2012-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 3
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 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 3
Number of participants with account balances 2011-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 3
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 3
Number of participants with account balances 2010-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 4
Total of all active and inactive participants 2009-01-01 4
Total participants 2009-01-01 4
Number of participants with account balances 2009-01-01 4

Measure	Date	Value
2016: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	6
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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	6
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	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	6
Number of participants with account balances	2015-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	4
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	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	4
Number of participants with account balances	2014-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1
2013: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	6
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	1
Total of all active and inactive participants	2013-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	3
Number of participants with account balances	2013-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	3
2012: DAVID J. PALMER, M.D., S.C. 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	4
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	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	4
Number of participants with account balances	2012-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3
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	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	3
Number of participants with account balances	2011-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	3
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	3
Number of participants with account balances	2010-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	4
Total of all active and inactive participants	2009-01-01	4
Total participants	2009-01-01	4
Number of participants with account balances	2009-01-01	4

Financial Data on DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN

Measure	Date	Value
2016 : DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan	2016-10-31	$0
Total plan liabilities at beginning of year	2016-10-31	$0
Total income from all sources	2016-10-31	$152,177
Expenses. Total of all expenses incurred	2016-10-31	$1,380,196
Benefits paid (including direct rollovers)	2016-10-31	$1,380,196
Total plan assets at end of year	2016-10-31	$0
Total plan assets at beginning of year	2016-10-31	$1,228,019
Value of fidelity bond covering the plan	2016-10-31	$130,000
Total contributions received or receivable from participants	2016-10-31	$0
Expenses. Other expenses not covered elsewhere	2016-10-31	$0
Contributions received from other sources (not participants or employers)	2016-10-31	$0
Other income received	2016-10-31	$102,803
Noncash contributions received	2016-10-31	$0
Net income (gross income less expenses)	2016-10-31	$-1,228,019
Net plan assets at end of year (total assets less liabilities)	2016-10-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-10-31	$1,228,019
Total contributions received or receivable from employer(s)	2016-10-31	$49,374
Value of certain deemed distributions of participant loans	2016-10-31	$0
Value of corrective distributions	2016-10-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-10-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-10-31	$0
2015 : DAVID J. PALMER, M.D., S.C. 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	$16,817
Expenses. Total of all expenses incurred	2015-12-31	$8,928
Benefits paid (including direct rollovers)	2015-12-31	$2,244
Total plan assets at end of year	2015-12-31	$1,228,019
Total plan assets at beginning of year	2015-12-31	$1,220,130
Value of fidelity bond covering the plan	2015-12-31	$130,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$6,684
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-13,183
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$7,889
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,228,019
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,220,130
Total contributions received or receivable from employer(s)	2015-12-31	$30,000
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : DAVID J. PALMER, M.D., S.C. 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	$105,007
Expenses. Total of all expenses incurred	2014-12-31	$10,850
Benefits paid (including direct rollovers)	2014-12-31	$4,166
Total plan assets at end of year	2014-12-31	$1,220,130
Total plan assets at beginning of year	2014-12-31	$1,125,973
Value of fidelity bond covering the plan	2014-12-31	$130,000
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$4,284
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$54,838
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$94,157
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,220,130
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,125,973
Total contributions received or receivable from employer(s)	2014-12-31	$50,169
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	$2,400
2013 : DAVID J. PALMER, M.D., S.C. 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	$184,555
Expenses. Total of all expenses incurred	2013-12-31	$4,986
Benefits paid (including direct rollovers)	2013-12-31	$4,986
Total plan assets at end of year	2013-12-31	$1,125,973
Total plan assets at beginning of year	2013-12-31	$946,404
Total contributions received or receivable from participants	2013-12-31	$0
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	$142,555
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$179,569
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,125,973
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$946,404
Total contributions received or receivable from employer(s)	2013-12-31	$42,000
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	$0
2012 : DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$118,329
Expenses. Total of all expenses incurred	2012-12-31	$30,749
Benefits paid (including direct rollovers)	2012-12-31	$29,239
Total plan assets at end of year	2012-12-31	$946,404
Total plan assets at beginning of year	2012-12-31	$858,824
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$1,510
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$60,361
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$87,580
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$946,404
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$858,824
Total contributions received or receivable from employer(s)	2012-12-31	$57,968
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
2011 : DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$18,911
Expenses. Total of all expenses incurred	2011-12-31	$2,400
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$858,824
Total plan assets at beginning of year	2011-12-31	$842,313
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$2,400
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-11,089
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$16,511
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$858,824
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$842,313
Total contributions received or receivable from employer(s)	2011-12-31	$30,000
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
2010 : DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$84,737
Expenses. Total of all expenses incurred	2010-12-31	$2,400
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$842,313
Total plan assets at beginning of year	2010-12-31	$759,976
Total contributions received or receivable from participants	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$2,400
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$25,740
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$82,337
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$842,313
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$759,976
Total contributions received or receivable from employer(s)	2010-12-31	$58,997
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0

Form 5500 Responses for DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN

2016: DAVID J. PALMER, M.D., S.C. 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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: DAVID J. PALMER, M.D., S.C. 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: DAVID J. PALMER, M.D., S.C. 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: DAVID J. PALMER, M.D., S.C. 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
2012: DAVID J. PALMER, M.D., S.C. 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 – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: DAVID J. PALMER, M.D., S.C. 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
2010: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: DAVID J. PALMER, M.D., S.C. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

6560993

Policy instance

Insurance contract or identification number	6560993
Number of Individuals Covered	1
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $417
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $417
Insurance broker organization code?	3
Insurance broker name	RUBINOFF GROUP

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

6560993

Policy instance

Insurance contract or identification number	6560993
Number of Individuals Covered	1
Insurance policy start date	2013-08-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $417
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $417
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	RUBINOFF GROUP

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

6560993

Policy instance

Insurance contract or identification number	6560993
Number of Individuals Covered	1
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $426
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $426
Insurance broker organization code?	3
Insurance broker name	RUBINOFF GROUP

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

6560993

Policy instance

Insurance contract or identification number	6560993
Number of Individuals Covered	1
Insurance policy start date	2011-08-01
Insurance policy end date	2012-07-31
Total amount of commissions paid to insurance broker	USD $2,127
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,127
Insurance broker organization code?	3
Insurance broker name	RUBINOFF GROUP

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

SC0971111J

Policy instance

Insurance contract or identification number	SC0971111J
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )

Policy contract number

SC0971111J

Policy instance

Insurance contract or identification number	SC0971111J
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	CHARLES D. MILLER

Potentially related plans

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Company Name:	DAVID J. PALMER, M.D., S.C.
Employer identification number (EIN):	363503946
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)