401k Plan data: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN plan

UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN
Plan identification number	001

UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 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
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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. has sponsored the creation of one or more 401k plans.

Company Name: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C.

Employer identification number (EIN): 621008517

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 TIMOTHY VAUGHN 2023-10-05
001 2021-01-01 TIMOTHY VAUGHN 2022-10-14
001 2020-01-01
001 2019-01-01
001 2018-01-01 TIM VAUGHN 2019-10-13
001 2017-01-01
001 2016-01-01 DAVID NETHERTON
001 2015-01-01 DAVID NETHERTON
001 2014-01-01 DAVID NETHERTON 2015-07-21
001 2013-01-01 DAVID NETHERTON 2014-06-18
001 2012-01-01 DAVID NETHERTON 2013-05-30
001 2011-01-01 DAVID NETHERTON 2012-03-22
001 2010-01-01 DAVID NETHERTON 2011-10-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	TIMOTHY VAUGHN	2023-10-05
001	2021-01-01	TIMOTHY VAUGHN	2022-10-14
001	2020-01-01
001	2019-01-01
001	2018-01-01	TIM VAUGHN	2019-10-13
001	2017-01-01
001	2016-01-01	DAVID NETHERTON
001	2015-01-01	DAVID NETHERTON
001	2014-01-01	DAVID NETHERTON	2015-07-21
001	2013-01-01	DAVID NETHERTON	2014-06-18
001	2012-01-01	DAVID NETHERTON	2013-05-30
001	2011-01-01	DAVID NETHERTON	2012-03-22
001	2010-01-01	DAVID NETHERTON	2011-10-11

Plan Statistics for UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN

Measure Date Value
2018: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 68
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 47
Number of retired or separated participants receiving benefits 2018-01-01 8
Number of other retired or separated participants entitled to future benefits 2018-01-01 14
Total of all active and inactive participants 2018-01-01 69
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 69
Number of participants with account balances 2018-01-01 69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 7
2017: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 64
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 54
Number of retired or separated participants receiving benefits 2017-01-01 5
Number of other retired or separated participants entitled to future benefits 2017-01-01 6
Total of all active and inactive participants 2017-01-01 65
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 65
Number of participants with account balances 2017-01-01 65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 2
2016: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 45
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 38
Number of retired or separated participants receiving benefits 2016-01-01 4
Number of other retired or separated participants entitled to future benefits 2016-01-01 6
Total of all active and inactive participants 2016-01-01 48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 48
Number of participants with account balances 2016-01-01 48
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 1
2015: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 36
Number of retired or separated participants receiving benefits 2015-01-01 3
Number of other retired or separated participants entitled to future benefits 2015-01-01 3
Total of all active and inactive participants 2015-01-01 42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 42
Number of participants with account balances 2015-01-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0

Measure	Date	Value
2018: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	68
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	47
Number of retired or separated participants receiving benefits	2018-01-01	8
Number of other retired or separated participants entitled to future benefits	2018-01-01	14
Total of all active and inactive participants	2018-01-01	69
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	69
Number of participants with account balances	2018-01-01	69
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	7
2017: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	64
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	54
Number of retired or separated participants receiving benefits	2017-01-01	5
Number of other retired or separated participants entitled to future benefits	2017-01-01	6
Total of all active and inactive participants	2017-01-01	65
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	65
Number of participants with account balances	2017-01-01	65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	2
2016: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	45
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	38
Number of retired or separated participants receiving benefits	2016-01-01	4
Number of other retired or separated participants entitled to future benefits	2016-01-01	6
Total of all active and inactive participants	2016-01-01	48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	48
Number of participants with account balances	2016-01-01	48
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	1
2015: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	36
Number of retired or separated participants receiving benefits	2015-01-01	3
Number of other retired or separated participants entitled to future benefits	2015-01-01	3
Total of all active and inactive participants	2015-01-01	42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	42
Number of participants with account balances	2015-01-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0

Financial Data on UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2018 : UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$0
Total income from all sources	2018-12-31	$291,622
Expenses. Total of all expenses incurred	2018-12-31	$421,602
Benefits paid (including direct rollovers)	2018-12-31	$410,503
Total plan assets at end of year	2018-12-31	$8,474,546
Total plan assets at beginning of year	2018-12-31	$8,604,526
Value of fidelity bond covering the plan	2018-12-31	$682,000
Total contributions received or receivable from participants	2018-12-31	$210,041
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$-381,545
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$-129,980
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$8,474,546
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$8,604,526
Assets. Value of participant loans	2018-12-31	$138,693
Assets. Value of real-estate (other than employer real property)	2018-12-31	$0
Total contributions received or receivable from employer(s)	2018-12-31	$463,126
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$11,099
2017 : UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2017 401k financial data
Transfers to/from the plan	2017-12-31	$0
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$1,709,391
Expenses. Total of all expenses incurred	2017-12-31	$164,534
Benefits paid (including direct rollovers)	2017-12-31	$148,759
Total plan assets at end of year	2017-12-31	$8,611,768
Total plan assets at beginning of year	2017-12-31	$7,066,911
Value of fidelity bond covering the plan	2017-12-31	$500,000
Total contributions received or receivable from participants	2017-12-31	$245,960
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$304,410
Other income received	2017-12-31	$690,465
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$1,544,857
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$8,611,768
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$7,066,911
Assets. Value of participant loans	2017-12-31	$158,281
Assets. Value of real-estate (other than employer real property)	2017-12-31	$230,000
Total contributions received or receivable from employer(s)	2017-12-31	$468,556
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$15,775
2016 : UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$928,651
Expenses. Total of all expenses incurred	2016-12-31	$110,067
Benefits paid (including direct rollovers)	2016-12-31	$96,906
Total plan assets at end of year	2016-12-31	$7,066,911
Total plan assets at beginning of year	2016-12-31	$6,248,327
Value of fidelity bond covering the plan	2016-12-31	$500,000
Total contributions received or receivable from participants	2016-12-31	$216,610
Expenses. Other expenses not covered elsewhere	2016-12-31	$8,053
Contributions received from other sources (not participants or employers)	2016-12-31	$14,258
Other income received	2016-12-31	$345,676
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$818,584
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$7,066,911
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$6,248,327
Assets. Value of participant loans	2016-12-31	$102,065
Assets. Value of real-estate (other than employer real property)	2016-12-31	$181,500
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2016-12-31	$80,158
Total contributions received or receivable from employer(s)	2016-12-31	$352,107
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$5,108
2015 : UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2015 401k financial data
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	$505,724
Expenses. Total of all expenses incurred	2015-12-31	$253,861
Benefits paid (including direct rollovers)	2015-12-31	$229,926
Total plan assets at end of year	2015-12-31	$6,248,327
Total plan assets at beginning of year	2015-12-31	$5,996,464
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$177,264
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$19,145
Other income received	2015-12-31	$-26,290
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$251,863
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$6,248,327
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$5,996,464
Assets. Value of participant loans	2015-12-31	$98,913
Assets. Value of real-estate (other than employer real property)	2015-12-31	$177,500
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2015-12-31	$70,189
Total contributions received or receivable from employer(s)	2015-12-31	$335,605
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	$23,935
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0

Form 5500 Responses for UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN

2018: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) PROFIT SHARING PLAN 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 – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 401(K) 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	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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C. 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

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Company Name:	UPPER CUMBERLAND ORTHOPEDIC SURGERY, P.C.
Employer identification number (EIN):	621008517
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)