401k Plan data: TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN plan

TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 401k Plan overview

Plan Name	TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN
Plan identification number	001

TIBBETTS ORTHODONTICS, P.C. RETIREMENT 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.
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

TIBBETTS ORTHODONTICS, P.C. has sponsored the creation of one or more 401k plans.

Company Name: TIBBETTS ORTHODONTICS, P.C.

Employer identification number (EIN): 160994242

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Additional information about TIBBETTS ORTHODONTICS, P.C.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1972-03-28

Company Identification Number: 326512

Legal Registered Office Address: 5353 MAIN ST
Erie
WILLIAMSVILLE
United States of America (USA)
14221

More information about TIBBETTS ORTHODONTICS, P.C.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01 JOHN TIBBETTS 2018-01-19 JOHN TIBBETTS 2018-01-19
001 2016-01-01 JOHN R TIBBETTS 2017-06-12 JOHN R TIBBETTS 2017-06-12
001 2015-01-01 JOHN R TIBBETTS 2016-10-03 JOHN R TIBBETTS 2016-10-03
001 2014-01-01 JOHN TIBBETTS 2015-10-12 JOHN TIBBETTS 2015-10-12
001 2013-01-01 JOHN R TIBBETTS JOHN R TIBBETTS 2014-06-13
001 2012-01-01 JOHN TIBBETTS JOHN TIBBETTS 2013-07-23
001 2011-01-01 JOHN TIBBETTS JOHN TIBBETTS 2012-09-10
001 2009-01-01 JOHN TIBBETTS JOHN TIBBETTS 2010-07-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2017-01-01	JOHN TIBBETTS	2018-01-19	JOHN TIBBETTS	2018-01-19
001	2016-01-01	JOHN R TIBBETTS	2017-06-12	JOHN R TIBBETTS	2017-06-12
001	2015-01-01	JOHN R TIBBETTS	2016-10-03	JOHN R TIBBETTS	2016-10-03
001	2014-01-01	JOHN TIBBETTS	2015-10-12	JOHN TIBBETTS	2015-10-12
001	2013-01-01	JOHN R TIBBETTS		JOHN R TIBBETTS	2014-06-13
001	2012-01-01	JOHN TIBBETTS		JOHN TIBBETTS	2013-07-23
001	2011-01-01	JOHN TIBBETTS		JOHN TIBBETTS	2012-09-10
001	2009-01-01	JOHN TIBBETTS		JOHN TIBBETTS	2010-07-27

Plan Statistics for TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN

401k plan membership statisitcs for TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN

Measure Date Value
2013: TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 5
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 1
Total of all active and inactive participants 2013-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 6
Number of participants with account balances 2013-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 5
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 2
Total of all active and inactive participants 2012-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 7
Number of participants with account balances 2012-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 6
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 2
Total of all active and inactive participants 2011-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 8
Number of participants with account balances 2011-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 8
2009: TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 12
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 5
Total of all active and inactive participants 2009-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 11
Number of participants with account balances 2009-01-01 11
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: TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	5
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	1
Total of all active and inactive participants	2013-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	6
Number of participants with account balances	2013-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	5
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	2
Total of all active and inactive participants	2012-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	7
Number of participants with account balances	2012-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	6
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	2
Total of all active and inactive participants	2011-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	8
Number of participants with account balances	2011-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	8
2009: TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	12
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	5
Total of all active and inactive participants	2009-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	11
Number of participants with account balances	2009-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN

Measure	Date	Value
2013 : TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$156,268
Expenses. Total of all expenses incurred	2013-12-31	$64,051
Benefits paid (including direct rollovers)	2013-12-31	$59,429
Total plan assets at end of year	2013-12-31	$837,740
Total plan assets at beginning of year	2013-12-31	$745,523
Value of fidelity bond covering the plan	2013-12-31	$100,000
Total contributions received or receivable from participants	2013-12-31	$32,774
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$113,649
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$92,217
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$837,740
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$745,523
Assets. Value of participant loans	2013-12-31	$34,513
Total contributions received or receivable from employer(s)	2013-12-31	$9,845
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$4,622
2012 : TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$114,865
Expenses. Total of all expenses incurred	2012-12-31	$6,958
Benefits paid (including direct rollovers)	2012-12-31	$202
Total plan assets at end of year	2012-12-31	$745,523
Total plan assets at beginning of year	2012-12-31	$637,616
Value of fidelity bond covering the plan	2012-12-31	$100,000
Total contributions received or receivable from participants	2012-12-31	$32,819
Other income received	2012-12-31	$72,758
Net income (gross income less expenses)	2012-12-31	$107,907
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$745,523
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$637,616
Assets. Value of participant loans	2012-12-31	$43,984
Total contributions received or receivable from employer(s)	2012-12-31	$9,288
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$6,756
2011 : TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2011 401k financial data
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$42,986
Expenses. Total of all expenses incurred	2011-12-31	$6,252
Benefits paid (including direct rollovers)	2011-12-31	$48
Total plan assets at end of year	2011-12-31	$637,616
Total plan assets at beginning of year	2011-12-31	$600,882
Value of fidelity bond covering the plan	2011-12-31	$100,000
Total contributions received or receivable from participants	2011-12-31	$32,695
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$792
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$36,734
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$637,616
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$600,882
Total contributions received or receivable from employer(s)	2011-12-31	$9,499
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$6,204
2010 : TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$109,780
Expenses. Total of all expenses incurred	2010-12-31	$39,693
Benefits paid (including direct rollovers)	2010-12-31	$34,000
Total plan assets at end of year	2010-12-31	$600,882
Total plan assets at beginning of year	2010-12-31	$530,795
Value of fidelity bond covering the plan	2010-12-31	$100,000
Total contributions received or receivable from participants	2010-12-31	$31,714
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$67,342
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$70,087
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$600,882
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$530,795
Total contributions received or receivable from employer(s)	2010-12-31	$10,724
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	$5,693

Form 5500 Responses for TIBBETTS ORTHODONTICS, P.C. RETIREMENT PLAN

2013: TIBBETTS ORTHODONTICS, P.C. RETIREMENT 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	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: TIBBETTS ORTHODONTICS, P.C. RETIREMENT 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 is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: TIBBETTS ORTHODONTICS, P.C. RETIREMENT 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 is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: TIBBETTS ORTHODONTICS, P.C. RETIREMENT 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 is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

IND POL

Policy instance

Insurance contract or identification number	IND POL
Number of Individuals Covered	2
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,032
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Other information about contract	INDIVIDUAL ANNUITY CONTRACTS
Commission paid to Insurance Broker	USD $4,032
Insurance broker organization code?	3
Insurance broker name	VICTOR ANASTASIA

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

80719

Policy instance

Insurance contract or identification number	80719
Number of Individuals Covered	6
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,279
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Commission paid to Insurance Broker	USD $1,006
Insurance broker organization code?	3
Insurance broker name	ACTUARIAL CONSULTING SERVICES, INC.

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

IND POL

Policy instance

Insurance contract or identification number	IND POL
Number of Individuals Covered	2
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,858
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	INDIVIDUAL ANNUITY CONTRACTS
Commission paid to Insurance Broker	USD $3,858
Insurance broker organization code?	3
Insurance broker name	VICTOR ANASTASIA

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

80719

Policy instance

Insurance contract or identification number	80719
Number of Individuals Covered	7
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,188
Total amount of fees paid to insurance company	USD $94
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,188
Insurance broker organization code?	3
Amount paid for insurance broker fees	94
Insurance broker name	ACTUARIAL CONSULTING SERVICES, INC.

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

IND POL

Policy instance

Insurance contract or identification number	IND POL
Number of Individuals Covered	2
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,404
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	INDIVIDUAL ANNUITY CONTRACTS

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

80719

Policy instance

Insurance contract or identification number	80719
Number of Individuals Covered	8
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,340
Total amount of fees paid to insurance company	USD $219
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

IND POL

Policy instance

Insurance contract or identification number	IND POL
Number of Individuals Covered	2
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $8,438
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	INDIVIDUAL ANNUITY CONTRACTS
Commission paid to Insurance Broker	USD $8,438
Insurance broker organization code?	3
Insurance broker name	VICTOR ANASTASIA

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

80719

Policy instance

Insurance contract or identification number	80719
Number of Individuals Covered	9
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,625
Total amount of fees paid to insurance company	USD $403
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,625
Insurance broker organization code?	3
Amount paid for insurance broker fees	403
Additional information about fees paid to insurance broker	TPA FEES PAID
Insurance broker name	ACTUARIAL CONSULTING SERVICES, INC.

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Company Name:	TIBBETTS ORTHODONTICS, P.C.
Employer identification number (EIN):	160994242
NAIC Classification:	621210
NAIC Description:	Offices of Dentists

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1972-03-28
Company Identification Number:	326512
Legal Registered Office Address:	5353 MAIN ST Erie WILLIAMSVILLE United States of America (USA) 14221