401k Plan data: THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST plan

THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST 401k Plan overview

Plan Name	THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST
Plan identification number	003

THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
Cash balance or similar plan - Plan has a "cash balance" formula. For this purpose, a "cash balance" formula is a benefit formula in a defined benefit plan by whatever name (for example, personal account plan, pension equity plan, life cycle plan, cash account plan, etc.) that rather than, or in addition to, expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee in terms more common to a defined contribution plan such as a single sum distribution amount (for example, 10 percent of final average pay times years of service, or the amount of the employee's hypothetical account balance).
Plan covered by PBGC that was terminated and closed out for PBGC purposes - Before the end of the plan year (or a prior plan year), (1) the plan terminated in a standard (or distress) termination and completed the distribution of plan assets in satisfaction of all benefit liabilities (or all ERISA Title IV benefits for distress termination); or (2) a trustee was appointed for a terminated plan pursuant to ERISA section 4042.

401k Sponsoring company profile

THUNDER BAY CLINIC MANAGEMENT, INC. has sponsored the creation of one or more 401k plans.

Company Name: THUNDER BAY CLINIC MANAGEMENT, INC.

Employer identification number (EIN): 383246843

NAIC Classification: 541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2012-01-01 BRADLEY A BOEHM 2013-03-21 BRADLEY A BOEHM 2013-03-21
003 2011-01-01 BRADLEY A BOEHM 2012-09-26 BRADLEY A BOEHM 2012-09-26
003 2010-01-01 BRADLEY A BOEHM BRADLEY A BOEHM 2011-10-17
003 2009-01-01 BRADLEY A. BOEHM, D.O. BRADLEY A. BOEHM, D.O. 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2012-01-01	BRADLEY A BOEHM	2013-03-21	BRADLEY A BOEHM	2013-03-21
003	2011-01-01	BRADLEY A BOEHM	2012-09-26	BRADLEY A BOEHM	2012-09-26
003	2010-01-01	BRADLEY A BOEHM		BRADLEY A BOEHM	2011-10-17
003	2009-01-01	BRADLEY A. BOEHM, D.O.		BRADLEY A. BOEHM, D.O.	2010-10-15

Plan Statistics for THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST

401k plan membership statisitcs for THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST

Measure Date Value
2010: THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 6
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 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 6
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 0
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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2010: THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	6
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	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	6
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	0
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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST

Measure	Date	Value
2010 : THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST 2010 401k financial data
Total income from all sources	2010-12-31	$53,237
Expenses. Total of all expenses incurred	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$261,623
Total plan assets at beginning of year	2010-12-31	$208,386
Other income received	2010-12-31	$41,121
Net income (gross income less expenses)	2010-12-31	$53,237
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$261,623
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$208,386
Total contributions received or receivable from employer(s)	2010-12-31	$12,116

Form 5500 Responses for THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST

2010: THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST 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 – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: THUNDER BAY CLINIC MANAGEMENT, INC. CASH BALANCE PENSION PLAN & TRUST 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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	THUNDER BAY CLINIC MANAGEMENT, INC.
Employer identification number (EIN):	383246843
NAIC Classification:	541600