401k Plan data: CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K) plan

CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K) 401k Plan overview

Plan Name	CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K)
Plan identification number	001

CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K) Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

NORTHEAST GEORGIA ANESTHESIA SER has sponsored the creation of one or more 401k plans.

Company Name: NORTHEAST GEORGIA ANESTHESIA SER

Employer identification number (EIN): 582255816

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 NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K)

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01 SIDNEY HOLLADAY 2021-10-14 SIDNEY HOLLADAY 2021-10-14
001 2019-01-01
001 2018-01-01 DAWNETTA JANENNE HOLLADAY 2019-08-01 DAWNETTA JANENNE HOLLADAY 2019-08-01
001 2017-01-01 SHANNON HALEY
001 2016-01-01 DAWNETTA JANENE HOLLADAY 2018-06-08
001 2015-01-01 STEVEN M WEIDLER 2016-07-26 STEVEN M WEIDLER 2016-07-26
001 2014-01-01 STEVEN M WEIDLER 2015-07-09 STEVEN M WEIDLER 2015-07-09
001 2013-01-01 STEVEN M WEIDLER 2014-09-11 STEVEN M WEIDLER 2014-09-11
001 2012-01-01 STEVEN WEIDLER 2013-07-24
001 2011-01-01 STEVEN WEIDLER 2012-07-19
001 2010-01-01 STEVEN WEIDLER 2011-08-04

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2020-01-01	SIDNEY HOLLADAY	2021-10-14	SIDNEY HOLLADAY	2021-10-14
001	2019-01-01
001	2018-01-01	DAWNETTA JANENNE HOLLADAY	2019-08-01	DAWNETTA JANENNE HOLLADAY	2019-08-01
001	2017-01-01	SHANNON HALEY
001	2016-01-01	DAWNETTA JANENE HOLLADAY	2018-06-08
001	2015-01-01	STEVEN M WEIDLER	2016-07-26	STEVEN M WEIDLER	2016-07-26
001	2014-01-01	STEVEN M WEIDLER	2015-07-09	STEVEN M WEIDLER	2015-07-09
001	2013-01-01	STEVEN M WEIDLER	2014-09-11	STEVEN M WEIDLER	2014-09-11
001	2012-01-01	STEVEN WEIDLER	2013-07-24
001	2011-01-01	STEVEN WEIDLER	2012-07-19
001	2010-01-01	STEVEN WEIDLER	2011-08-04

Plan Statistics for CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K)

401k plan membership statisitcs for CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K)

Measure Date Value
2017: CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K) 2017 401k membership
Total participants, beginning-of-year 2017-01-01 158
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 74
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 24
Total of all active and inactive participants 2017-01-01 98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 98
Number of participants with account balances 2017-01-01 57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 1
2016: CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K) 2016 401k membership
Total participants, beginning-of-year 2016-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 149
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 14
Total of all active and inactive participants 2016-01-01 163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 163
Number of participants with account balances 2016-01-01 85
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0

Measure	Date	Value
2017: CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K) 2017 401k membership
Total participants, beginning-of-year	2017-01-01	158
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	74
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	24
Total of all active and inactive participants	2017-01-01	98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	98
Number of participants with account balances	2017-01-01	57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	1
2016: CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K) 2016 401k membership
Total participants, beginning-of-year	2016-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	149
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	14
Total of all active and inactive participants	2016-01-01	163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	163
Number of participants with account balances	2016-01-01	85
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0

Financial Data on CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K)

Measure	Date	Value
2017 : CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K) 2017 401k financial data
Unrealized appreciation/depreciation of real estate assets	2017-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2017-12-31	$0
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Expenses. Interest paid	2017-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$1,061,166
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$417,840
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$414,020
Expenses. Certain deemed distributions of participant loans	2017-12-31	$0
Value of total corrective distributions	2017-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$345,583
Value of total assets at end of year	2017-12-31	$5,099,071
Value of total assets at beginning of year	2017-12-31	$4,455,745
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$3,820
Total income from rents	2017-12-31	$0
Total interest from all sources	2017-12-31	$12,293
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$0
Administrative expenses professional fees incurred	2017-12-31	$0
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$232,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$213,137
Participant contributions at end of year	2017-12-31	$152,236
Participant contributions at beginning of year	2017-12-31	$235,020
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2017-12-31	$0
Other income not declared elsewhere	2017-12-31	$0
Administrative expenses (other) incurred	2017-12-31	$3,820
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Income. Non cash contributions	2017-12-31	$0
Value of net income/loss	2017-12-31	$643,326
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$5,099,071
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$4,455,745
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Investment advisory and management fees	2017-12-31	$0
Value of interest in pooled separate accounts at end of year	2017-12-31	$4,771,592
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$4,067,043
Interest on participant loans	2017-12-31	$7,624
Income. Interest from loans (other than to participants)	2017-12-31	$0
Interest earned on other investments	2017-12-31	$4,669
Income. Interest from US Government securities	2017-12-31	$0
Income. Interest from corporate debt instruments	2017-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$175,243
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$153,682
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$0
Net investment gain/loss from pooled separate accounts	2017-12-31	$703,290
Net investment gain or loss from common/collective trusts	2017-12-31	$0
Net gain/loss from 103.12 investment entities	2017-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$132,446
Income. Dividends from preferred stock	2017-12-31	$0
Income. Dividends from common stock	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$414,020
Contract administrator fees	2017-12-31	$0
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Aggregate proceeds on sale of assets	2017-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2017-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	J. ALLEN SEYMOUR CPA, P.C.
Accountancy firm EIN	2017-12-31	581829296
2016 : CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K) 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets	2016-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2016-12-31	$0
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Expenses. Interest paid	2016-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$931,427
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$686,296
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$683,908
Expenses. Certain deemed distributions of participant loans	2016-12-31	$0
Value of total corrective distributions	2016-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$573,978
Value of total assets at end of year	2016-12-31	$4,455,745
Value of total assets at beginning of year	2016-12-31	$4,210,614
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$2,388
Total income from rents	2016-12-31	$0
Total interest from all sources	2016-12-31	$14,767
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$0
Administrative expenses professional fees incurred	2016-12-31	$0
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$232,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$345,129
Participant contributions at end of year	2016-12-31	$235,020
Participant contributions at beginning of year	2016-12-31	$106,850
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$24,352
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-12-31	$0
Other income not declared elsewhere	2016-12-31	$0
Administrative expenses (other) incurred	2016-12-31	$2,388
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Income. Non cash contributions	2016-12-31	$0
Value of net income/loss	2016-12-31	$245,131
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$4,455,745
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$4,210,614
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Investment advisory and management fees	2016-12-31	$0
Value of interest in pooled separate accounts at end of year	2016-12-31	$4,067,043
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$3,883,955
Interest on participant loans	2016-12-31	$10,344
Income. Interest from loans (other than to participants)	2016-12-31	$0
Interest earned on other investments	2016-12-31	$4,423
Income. Interest from US Government securities	2016-12-31	$0
Income. Interest from corporate debt instruments	2016-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$153,682
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$219,809
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$0
Net investment gain/loss from pooled separate accounts	2016-12-31	$342,682
Net investment gain or loss from common/collective trusts	2016-12-31	$0
Net gain/loss from 103.12 investment entities	2016-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$204,497
Income. Dividends from preferred stock	2016-12-31	$0
Income. Dividends from common stock	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$683,908
Contract administrator fees	2016-12-31	$0
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Aggregate proceeds on sale of assets	2016-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2016-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	J. ALLEN SEYMOUR, CPA, P.C.
Accountancy firm EIN	2016-12-31	581829296

Form 5500 Responses for CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K)

2017: CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K) 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: CENTER FOR NON-SURGICAL SPINE CARE & PAIN MANAGEMENT 401(K) 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	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

319421

Policy instance

Insurance contract or identification number	319421
Number of Individuals Covered	57
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14,369
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $8,826
Insurance broker organization code?	3
Insurance broker name	WOODBURY FINANCIAL SERVICES

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See full terms and conditions

Company Name:	NORTHEAST GEORGIA ANESTHESIA SER
Employer identification number (EIN):	582255816
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)