401k Plan data: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN plan

CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 401k Plan overview

Plan Name	CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN
Plan identification number	001

CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 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.
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

CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY has sponsored the creation of one or more 401k plans.

Company Name: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY

Employer identification number (EIN): 911085818

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 LISA GOVAERT LISA GOVAERT 2014-01-09
001 2012-01-01 LISA GOVAERT
001 2011-01-01 LISA GOVAERT
001 2010-01-01 LISA GOVAERT
001 2009-01-01 LISA GOVAERT

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2013-01-01	LISA GOVAERT	LISA GOVAERT	2014-01-09
001	2012-01-01	LISA GOVAERT
001	2011-01-01	LISA GOVAERT
001	2010-01-01	LISA GOVAERT
001	2009-01-01	LISA GOVAERT

Plan Statistics for CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN

401k plan membership statisitcs for CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN

Measure Date Value
2013: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 0
Number of participants with account balances 2013-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 41
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 18
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 21
Total of all active and inactive participants 2012-01-01 39
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 39
Number of participants with account balances 2012-01-01 38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 21
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 20
Total of all active and inactive participants 2011-01-01 41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 41
Number of participants with account balances 2011-01-01 39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 22
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 17
Total of all active and inactive participants 2010-01-01 39
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 39
Number of participants with account balances 2010-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 31
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 21
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 19
Total of all active and inactive participants 2009-01-01 40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 40
Number of participants with account balances 2009-01-01 31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2013: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	0
Number of participants with account balances	2013-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	41
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	18
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	21
Total of all active and inactive participants	2012-01-01	39
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	39
Number of participants with account balances	2012-01-01	38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	21
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	20
Total of all active and inactive participants	2011-01-01	41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	41
Number of participants with account balances	2011-01-01	39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	22
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	17
Total of all active and inactive participants	2010-01-01	39
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	39
Number of participants with account balances	2010-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	21
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	19
Total of all active and inactive participants	2009-01-01	40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	40
Number of participants with account balances	2009-01-01	31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN

Measure	Date	Value
2013 : CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2013 401k financial data
Total income from all sources	2013-12-10	$307,437
Expenses. Total of all expenses incurred	2013-12-10	$1,333,735
Benefits paid (including direct rollovers)	2013-12-10	$1,330,109
Total plan assets at end of year	2013-12-10	$0
Total plan assets at beginning of year	2013-12-10	$1,026,298
Value of fidelity bond covering the plan	2013-12-10	$125,000
Total contributions received or receivable from participants	2013-12-10	$51,257
Other income received	2013-12-10	$194,920
Net income (gross income less expenses)	2013-12-10	$-1,026,298
Net plan assets at end of year (total assets less liabilities)	2013-12-10	$0
Net plan assets at beginning of year (total assets less liabilities)	2013-12-10	$1,026,298
Assets. Value of participant loans	2013-12-10	$0
Total contributions received or receivable from employer(s)	2013-12-10	$61,260
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-10	$3,626
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-10	$0
2012 : CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$207,076
Expenses. Total of all expenses incurred	2012-12-31	$55,365
Benefits paid (including direct rollovers)	2012-12-31	$52,560
Total plan assets at end of year	2012-12-31	$1,026,298
Total plan assets at beginning of year	2012-12-31	$874,587
Value of fidelity bond covering the plan	2012-12-31	$125,000
Total contributions received or receivable from participants	2012-12-31	$50,039
Other income received	2012-12-31	$123,136
Net income (gross income less expenses)	2012-12-31	$151,711
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,026,298
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$874,587
Assets. Value of participant loans	2012-12-31	$10,702
Total contributions received or receivable from employer(s)	2012-12-31	$33,901
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$2,805
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$37,497
Expenses. Total of all expenses incurred	2011-12-31	$2,692
Benefits paid (including direct rollovers)	2011-12-31	$257
Total plan assets at end of year	2011-12-31	$874,587
Total plan assets at beginning of year	2011-12-31	$839,782
Value of fidelity bond covering the plan	2011-12-31	$75,000
Total contributions received or receivable from participants	2011-12-31	$34,919
Other income received	2011-12-31	$-29,515
Net income (gross income less expenses)	2011-12-31	$34,805
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$874,587
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$839,782
Assets. Value of participant loans	2011-12-31	$16,121
Total contributions received or receivable from employer(s)	2011-12-31	$32,093
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$2,435
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$188,845
Expenses. Total of all expenses incurred	2010-12-31	$62,808
Benefits paid (including direct rollovers)	2010-12-31	$60,430
Total plan assets at end of year	2010-12-31	$839,782
Total plan assets at beginning of year	2010-12-31	$713,745
Value of fidelity bond covering the plan	2010-12-31	$75,000
Total contributions received or receivable from participants	2010-12-31	$54,328
Other income received	2010-12-31	$91,355
Net income (gross income less expenses)	2010-12-31	$126,037
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$839,782
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$713,745
Assets. Value of participant loans	2010-12-31	$30,631
Total contributions received or receivable from employer(s)	2010-12-31	$43,162
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	$2,378
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN

2013: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) 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	Yes
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) 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 funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) 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 funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) 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 funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY 401(K) PLAN 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 funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	CHILDREN'S CLINIC OF SOUTH SNOHOMISH COUNTY
Employer identification number (EIN):	911085818
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)