401k Plan data: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K plan

CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 401k Plan overview

Plan Name	CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K
Plan identification number	001

CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 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.
Plan sponsor(s) received services of leased employees, as defined in Code section 414(n), during the plan year.

401k Sponsoring company profile

CAPITOL INTERNAL MEDICINE ASSOCI has sponsored the creation of one or more 401k plans.

Company Name: CAPITOL INTERNAL MEDICINE ASSOCI

Employer identification number (EIN): 204206516

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 DHEERAJ KAMRA 2023-10-25
001 2021-01-01 DHEERAJ KAMRA 2022-08-03
001 2020-01-01 JOE WINTERS 2021-06-21
001 2019-01-01 JOE WINTERS 2020-07-13
001 2018-01-01 JOE WINTERS 2019-07-23
001 2017-01-01 JOE WINTERS 2018-06-19
001 2016-01-01 DHEERAJ KAMRA
001 2015-01-01 DHEERAJ KAMRA
001 2014-01-01 DHEERAJ KAMRA
001 2013-01-01 DHEERAJ KAMRA 2014-08-11
001 2012-01-01 DHEERAJ KAMRA MD A PROFESSIONA 2013-07-22
001 2011-01-01 DHEERAJ KAMRA MD A PROFESSIONA

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	DHEERAJ KAMRA	2023-10-25
001	2021-01-01	DHEERAJ KAMRA	2022-08-03
001	2020-01-01	JOE WINTERS	2021-06-21
001	2019-01-01	JOE WINTERS	2020-07-13
001	2018-01-01	JOE WINTERS	2019-07-23
001	2017-01-01	JOE WINTERS	2018-06-19
001	2016-01-01	DHEERAJ KAMRA
001	2015-01-01	DHEERAJ KAMRA
001	2014-01-01	DHEERAJ KAMRA
001	2013-01-01	DHEERAJ KAMRA	2014-08-11
001	2012-01-01	DHEERAJ KAMRA MD A PROFESSIONA	2013-07-22
001	2011-01-01	DHEERAJ KAMRA MD A PROFESSIONA

Plan Statistics for CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K

401k plan membership statisitcs for CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K

Measure Date Value
2016: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2016 401k membership
Total participants, beginning-of-year 2016-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 11
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 11
Number of participants with account balances 2016-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2015 401k membership
Total participants, beginning-of-year 2015-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 5
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 5
Number of participants with account balances 2015-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2014 401k membership
Total participants, beginning-of-year 2014-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 7
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 7
Number of participants with account balances 2014-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2011: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2011 401k membership
Total participants, beginning-of-year 2011-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 5
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 0
Total of all active and inactive participants 2011-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 5
Number of participants with account balances 2011-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2016: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2016 401k membership
Total participants, beginning-of-year	2016-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	11
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	11
Number of participants with account balances	2016-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2015 401k membership
Total participants, beginning-of-year	2015-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	5
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	5
Number of participants with account balances	2015-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2014 401k membership
Total participants, beginning-of-year	2014-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	7
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	7
Number of participants with account balances	2014-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2011: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2011 401k membership
Total participants, beginning-of-year	2011-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	5
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	0
Total of all active and inactive participants	2011-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	5
Number of participants with account balances	2011-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K

Measure	Date	Value
2016 : CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 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	$-7,987
Expenses. Total of all expenses incurred	2016-12-31	$0
Benefits paid (including direct rollovers)	2016-12-31	$0
Total plan assets at end of year	2016-12-31	$196,764
Total plan assets at beginning of year	2016-12-31	$204,751
Value of fidelity bond covering the plan	2016-12-31	$20,475
Total contributions received or receivable from participants	2016-12-31	$15,415
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$-38,048
Net income (gross income less expenses)	2016-12-31	$-7,987
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$196,764
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$204,751
Total contributions received or receivable from employer(s)	2016-12-31	$14,646
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	$0
2015 : CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
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	$50,462
Expenses. Total of all expenses incurred	2015-12-31	$0
Benefits paid (including direct rollovers)	2015-12-31	$0
Total plan assets at end of year	2015-12-31	$204,751
Total plan assets at beginning of year	2015-12-31	$154,289
Value of fidelity bond covering the plan	2015-12-31	$20,000
Total contributions received or receivable from participants	2015-12-31	$15,655
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$17,579
Net income (gross income less expenses)	2015-12-31	$50,462
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$204,751
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$154,289
Total contributions received or receivable from employer(s)	2015-12-31	$17,228
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	$0
2014 : CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$59,043
Expenses. Total of all expenses incurred	2014-12-31	$0
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$154,289
Total plan assets at beginning of year	2014-12-31	$95,246
Value of fidelity bond covering the plan	2014-12-31	$20,000
Total contributions received or receivable from participants	2014-12-31	$17,500
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$26,774
Net income (gross income less expenses)	2014-12-31	$59,043
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$154,289
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$95,246
Total contributions received or receivable from employer(s)	2014-12-31	$14,769
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$0
2011 : CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$41,608
Expenses. Total of all expenses incurred	2011-12-31	$0
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$41,608
Total plan assets at beginning of year	2011-12-31	$0
Value of fidelity bond covering the plan	2011-12-31	$20,000
Total contributions received or receivable from participants	2011-12-31	$16,844
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$18,176
Net income (gross income less expenses)	2011-12-31	$41,608
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$41,608
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$6,588
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	$0

Form 5500 Responses for CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K

2016: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 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: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 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
2014: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2011: CAPITOL INTERNAL MEDICINE ASSOCIATES DBA AMPLEHEALTH 401(K 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
2011-01-01	Submission has been amended	Yes
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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	CAPITOL INTERNAL MEDICINE ASSOCI
Employer identification number (EIN):	204206516
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)