401k Plan data: DAVIS OCCUPATIONAL MEDICINE 401K PLAN plan

DAVIS OCCUPATIONAL MEDICINE 401K PLAN 401k Plan overview

Plan Name	DAVIS OCCUPATIONAL MEDICINE 401K PLAN
Plan identification number	001

DAVIS OCCUPATIONAL MEDICINE 401K 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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

DAVIS OCCUPATIONAL MEDICINE has sponsored the creation of one or more 401k plans.

Company Name: DAVIS OCCUPATIONAL MEDICINE

Employer identification number (EIN): 043129970

NAIC Classification: 621399
NAIC Description: Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAVIS OCCUPATIONAL MEDICINE 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 JOHN DAVIS 2016-12-13
001 2015-01-01 JOHN DAVIS 2016-08-30
001 2014-01-01 CHRISTINE M. KILE 2015-10-06 JOHN A. DAVIS 2015-10-06
001 2013-01-01 CHRISTINE M. KILE 2014-09-30 JOHN A. DAVIS 2014-09-30
001 2012-01-01 CHRISTINE M. KILE 2013-10-01 JOHN A. DAVIS 2013-10-01
001 2011-01-01 CHRISTINE M. KILE 2012-10-09 JOHN A. DAVIS 2012-10-09
001 2010-01-01 CHRISTINE M. KILE 2011-08-09 JOHN A. DAVIS 2011-08-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	JOHN DAVIS	2016-12-13
001	2015-01-01	JOHN DAVIS	2016-08-30
001	2014-01-01	CHRISTINE M. KILE	2015-10-06	JOHN A. DAVIS	2015-10-06
001	2013-01-01	CHRISTINE M. KILE	2014-09-30	JOHN A. DAVIS	2014-09-30
001	2012-01-01	CHRISTINE M. KILE	2013-10-01	JOHN A. DAVIS	2013-10-01
001	2011-01-01	CHRISTINE M. KILE	2012-10-09	JOHN A. DAVIS	2012-10-09
001	2010-01-01	CHRISTINE M. KILE	2011-08-09	JOHN A. DAVIS	2011-08-09

Financial Data on DAVIS OCCUPATIONAL MEDICINE 401K PLAN

Measure	Date	Value
2008 : DAVIS OCCUPATIONAL MEDICINE 401K PLAN 2008 401k financial data
Total income from all sources	2008-12-31	$-127,106
Expenses. Total of all expenses incurred	2008-12-31	$0
Total plan assets at end of year	2008-12-31	$238,201
Total plan assets at beginning of year	2008-12-31	$365,307
Value of fidelity bond covering the plan	2008-12-31	$100,000
Other income received	2008-12-31	$-131,634
Net income (gross income less expenses)	2008-12-31	$-127,106
Net plan assets at end of year (total assets less liabilities)	2008-12-31	$238,201
Net plan assets at beginning of year (total assets less liabilities)	2008-12-31	$365,307
Assets. Value of participant loans	2008-12-31	$0
Total contributions received or receivable from employer(s)	2008-12-31	$4,528

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G97675

Policy instance

Insurance contract or identification number	G97675
Number of Individuals Covered	6
Insurance policy start date	2008-01-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $180
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $180
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	JONATHAN E PRICE

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Company Name:	DAVIS OCCUPATIONAL MEDICINE
Employer identification number (EIN):	043129970
NAIC Classification:	621399
NAIC Description:	Offices of All Other Miscellaneous Health Practitioners