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DAY SURGERY CENTER 401(K) RETIREMENT PLAN 401k Plan overview

Plan NameDAY SURGERY CENTER 401(K) RETIREMENT PLAN
Plan identification number 001

DAY SURGERY CENTER 401(K) RETIREMENT PLAN Benefits

401k Plan TypeDefined 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.
  • 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

PHYSICIANS OF WINTER HAVEN, LLC has sponsored the creation of one or more 401k plans.

Company Name:PHYSICIANS OF WINTER HAVEN, LLC
Employer identification number (EIN):200324393
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Additional information about PHYSICIANS OF WINTER HAVEN, LLC

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 2003-10-09
Company Identification Number: L03000039709
Legal Registered Office Address: 2400 DUNDEE ROAD

WINTER HAVEN

33884

More information about PHYSICIANS OF WINTER HAVEN, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAY SURGERY CENTER 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012021-01-01BETTY M LEES2022-04-18 BETTY M LEES2022-04-18
0012020-01-01BETTY LEES2021-04-28 BETTY LEES2021-04-28
0012018-01-01BETTY LEES2019-05-20 BETTY LEES2019-05-20
0012017-01-01BETTY LEES2018-05-10
0012016-01-01BETTY LEES2017-06-16 BETTY LEES2017-06-16
0012015-01-01BETY LEES2016-08-04
0012014-01-01BETTY LEES2015-08-06
0012013-01-01BETTY M. LEES
0012012-01-01BETTY M. LEES
0012011-01-01BETTY M. LEES
0012009-01-01BETTY M. LEES BETTY M. LEES2010-07-23

Plan Statistics for DAY SURGERY CENTER 401(K) RETIREMENT PLAN

401k plan membership statisitcs for DAY SURGERY CENTER 401(K) RETIREMENT PLAN

Measure Date Value
2013: DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0143
Total number of active participants reported on line 7a of the Form 55002013-01-0131
Number of retired or separated participants receiving benefits2013-01-011
Number of other retired or separated participants entitled to future benefits2013-01-015
Total of all active and inactive participants2013-01-0137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0137
Number of participants with account balances2013-01-0126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0143
Total number of active participants reported on line 7a of the Form 55002012-01-0128
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-015
Total of all active and inactive participants2012-01-0133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0133
Number of participants with account balances2012-01-0126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0130
Total number of active participants reported on line 7a of the Form 55002011-01-0125
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-016
Total of all active and inactive participants2011-01-0131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0131
Number of participants with account balances2011-01-0127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0131
Total number of active participants reported on line 7a of the Form 55002009-01-0127
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-013
Total of all active and inactive participants2009-01-0130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0130
Number of participants with account balances2009-01-0130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-013

Financial Data on DAY SURGERY CENTER 401(K) RETIREMENT PLAN

Measure Date Value
2013 : DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2013 401k financial data
Total income from all sources2013-12-31$97,911
Expenses. Total of all expenses incurred2013-12-31$20,476
Benefits paid (including direct rollovers)2013-12-31$16,458
Total plan assets at end of year2013-12-31$365,707
Total plan assets at beginning of year2013-12-31$288,272
Total contributions received or receivable from participants2013-12-31$33,899
Other income received2013-12-31$54,055
Net income (gross income less expenses)2013-12-31$77,435
Net plan assets at end of year (total assets less liabilities)2013-12-31$365,707
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$288,272
Total contributions received or receivable from employer(s)2013-12-31$9,957
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$4,018
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2012 401k financial data
Total income from all sources2012-12-31$70,205
Expenses. Total of all expenses incurred2012-12-31$17,243
Benefits paid (including direct rollovers)2012-12-31$13,661
Total plan assets at end of year2012-12-31$288,272
Total plan assets at beginning of year2012-12-31$235,310
Total contributions received or receivable from participants2012-12-31$31,389
Other income received2012-12-31$28,722
Net income (gross income less expenses)2012-12-31$52,962
Net plan assets at end of year (total assets less liabilities)2012-12-31$288,272
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$235,310
Total contributions received or receivable from employer(s)2012-12-31$10,094
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$3,582
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2011 401k financial data
Total income from all sources2011-12-31$43,838
Expenses. Total of all expenses incurred2011-12-31$11,515
Benefits paid (including direct rollovers)2011-12-31$8,278
Total plan assets at end of year2011-12-31$235,310
Total plan assets at beginning of year2011-12-31$202,987
Total contributions received or receivable from participants2011-12-31$35,279
Expenses. Other expenses not covered elsewhere2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$1,362
Other income received2011-12-31$-4,811
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$32,323
Net plan assets at end of year (total assets less liabilities)2011-12-31$235,310
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$202,987
Total contributions received or receivable from employer(s)2011-12-31$12,008
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$3,237
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2010 401k financial data
Total income from all sources2010-12-31$94,660
Expenses. Total of all expenses incurred2010-12-31$35,681
Benefits paid (including direct rollovers)2010-12-31$32,664
Total plan assets at end of year2010-12-31$202,987
Total plan assets at beginning of year2010-12-31$144,008
Total contributions received or receivable from participants2010-12-31$38,395
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$19,496
Other income received2010-12-31$23,992
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$58,979
Net plan assets at end of year (total assets less liabilities)2010-12-31$202,987
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$144,008
Total contributions received or receivable from employer(s)2010-12-31$12,777
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$3,017
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for DAY SURGERY CENTER 401(K) RETIREMENT PLAN

2013: DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: DAY SURGERY CENTER 401(K) RETIREMENT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number77815
Policy instance 1
Insurance contract or identification number77815
Number of Individuals Covered27
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,453
Total amount of fees paid to insurance companyUSD $65
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $1,291
Insurance broker organization code?3
Amount paid for insurance broker fees65
Additional information about fees paid to insurance brokerSALES/ADMINISTRATION
Insurance broker nameAMERICAN PENSION SERVICES, LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number77815
Policy instance 1
Insurance contract or identification number77815
Number of Individuals Covered27
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,027
Total amount of fees paid to insurance companyUSD $324
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $1,027
Insurance broker organization code?3
Amount paid for insurance broker fees324
Additional information about fees paid to insurance brokerSALES/ADMINISTRATION
Insurance broker nameAMERICAN PENSION SERVICES, LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number77815
Policy instance 1
Insurance contract or identification number77815
Number of Individuals Covered29
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $885
Total amount of fees paid to insurance companyUSD $348
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number77815
Policy instance 1
Insurance contract or identification number77815
Number of Individuals Covered27
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $668
Total amount of fees paid to insurance companyUSD $496
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $668
Insurance broker organization code?3
Amount paid for insurance broker fees496
Additional information about fees paid to insurance brokerSALES/ADMINISTRATION
Insurance broker nameAMERICAN PENSION SERVICES, LLC

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