401k Plan data: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST plan

TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 401k Plan overview

Plan Name	TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST
Plan identification number	002

TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.

401k Sponsoring company profile

TYLERDALE FAMILY MEDICINE, P.C. has sponsored the creation of one or more 401k plans.

Company Name: TYLERDALE FAMILY MEDICINE, P.C.

Employer identification number (EIN): 251244165

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2018-01-01 NICHOLAS E. FUERST 2018-10-11 DEBBIEKELLER 2018-10-11
002 2017-01-01 NICHOLAS E. FUERST 2018-10-11 DEBBIEKELLER 2018-10-11
002 2016-01-01 NICHOLAS E. FUERST 2017-10-16 DEBBIEKELLER 2017-10-16
002 2015-01-01 NICHOLAS E. FUERST 2016-10-17
002 2014-01-01 NICHOLAS E.FUERST
002 2013-01-01 NICHOLAS E.FUERST
002 2012-01-01 NICHOLAS E.FUERST
002 2011-01-01 DENNIS KITSKO
002 2009-01-01 DENNIS KITSKO

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2018-01-01	NICHOLAS E. FUERST	2018-10-11	DEBBIEKELLER	2018-10-11
002	2017-01-01	NICHOLAS E. FUERST	2018-10-11	DEBBIEKELLER	2018-10-11
002	2016-01-01	NICHOLAS E. FUERST	2017-10-16	DEBBIEKELLER	2017-10-16
002	2015-01-01	NICHOLAS E. FUERST	2016-10-17
002	2014-01-01	NICHOLAS E.FUERST
002	2013-01-01	NICHOLAS E.FUERST
002	2012-01-01	NICHOLAS E.FUERST
002	2011-01-01	DENNIS KITSKO
002	2009-01-01	DENNIS KITSKO

Plan Statistics for TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST

401k plan membership statisitcs for TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST

Measure Date Value
2014: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 14
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 1
Total of all active and inactive participants 2014-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 15
Number of participants with account balances 2014-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 15
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 3
Total of all active and inactive participants 2013-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 18
Number of participants with account balances 2013-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 11
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 3
Total of all active and inactive participants 2012-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 14
Number of participants with account balances 2012-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 16
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 11
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 3
Total of all active and inactive participants 2011-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 14
Number of participants with account balances 2011-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 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 11
Number of other retired or separated participants entitled to future benefits 2009-01-01 4
Total of all active and inactive participants 2009-01-01 15
Total participants 2009-01-01 15
Number of participants with account balances 2009-01-01 15

Measure	Date	Value
2014: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	14
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	1
Total of all active and inactive participants	2014-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	15
Number of participants with account balances	2014-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	15
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	3
Total of all active and inactive participants	2013-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	18
Number of participants with account balances	2013-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	11
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	3
Total of all active and inactive participants	2012-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	14
Number of participants with account balances	2012-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	16
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	11
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	3
Total of all active and inactive participants	2011-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	14
Number of participants with account balances	2011-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 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	11
Number of other retired or separated participants entitled to future benefits	2009-01-01	4
Total of all active and inactive participants	2009-01-01	15
Total participants	2009-01-01	15
Number of participants with account balances	2009-01-01	15

Financial Data on TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST

Measure	Date	Value
2014 : TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2014 401k financial data
Total income from all sources	2014-12-31	$123,123
Expenses. Total of all expenses incurred	2014-12-31	$20,434
Total plan assets at end of year	2014-12-31	$1,398,199
Total plan assets at beginning of year	2014-12-31	$1,295,510
Value of fidelity bond covering the plan	2014-12-31	$120,000
Total contributions received or receivable from participants	2014-12-31	$53,282
Other income received	2014-12-31	$46,886
Net income (gross income less expenses)	2014-12-31	$102,689
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,398,199
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,295,510
Assets. Value of participant loans	2014-12-31	$1,993
Total contributions received or receivable from employer(s)	2014-12-31	$22,955
Value of certain deemed distributions of participant loans	2014-12-31	$20,434
2013 : TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2013 401k financial data
Total income from all sources	2013-12-31	$173,425
Expenses. Total of all expenses incurred	2013-12-31	$37,018
Benefits paid (including direct rollovers)	2013-12-31	$18,838
Total plan assets at end of year	2013-12-31	$1,295,510
Total plan assets at beginning of year	2013-12-31	$1,159,103
Value of fidelity bond covering the plan	2013-12-31	$120,000
Total contributions received or receivable from participants	2013-12-31	$44,808
Contributions received from other sources (not participants or employers)	2013-12-31	$12,890
Other income received	2013-12-31	$97,312
Net income (gross income less expenses)	2013-12-31	$136,407
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,295,510
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,159,103
Total contributions received or receivable from employer(s)	2013-12-31	$18,415
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$18,180
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2012 401k financial data
Total income from all sources	2012-12-31	$150,162
Expenses. Total of all expenses incurred	2012-12-31	$17,053
Total plan assets at end of year	2012-12-31	$1,159,103
Total plan assets at beginning of year	2012-12-31	$1,025,994
Value of fidelity bond covering the plan	2012-12-31	$50,000
Total contributions received or receivable from participants	2012-12-31	$74,398
Expenses. Other expenses not covered elsewhere	2012-12-31	$17,053
Other income received	2012-12-31	$52,015
Net income (gross income less expenses)	2012-12-31	$133,109
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,159,103
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,025,994
Total contributions received or receivable from employer(s)	2012-12-31	$23,749
2011 : TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2011 401k financial data
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$94,769
Expenses. Total of all expenses incurred	2011-12-31	$16,933
Benefits paid (including direct rollovers)	2011-12-31	$1,341
Total plan assets at end of year	2011-12-31	$1,025,994
Total plan assets at beginning of year	2011-12-31	$948,158
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$74,280
Other income received	2011-12-31	$-12,677
Net income (gross income less expenses)	2011-12-31	$77,836
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,025,994
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$948,158
Total contributions received or receivable from employer(s)	2011-12-31	$33,166
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$15,592
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 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	$187,954
Expenses. Total of all expenses incurred	2010-12-31	$31,189
Benefits paid (including direct rollovers)	2010-12-31	$15,561
Total plan assets at end of year	2010-12-31	$948,158
Total plan assets at beginning of year	2010-12-31	$791,393
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$53,842
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$18,739
Other income received	2010-12-31	$90,751
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$156,765
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$948,158
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$791,393
Total contributions received or receivable from employer(s)	2010-12-31	$24,622
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	$15,628
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2008 : TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2008 401k financial data
Total income from all sources	2008-12-31	$-152,134
Expenses. Total of all expenses incurred	2008-12-31	$9,273
Total plan assets at end of year	2008-12-31	$640,986
Total plan assets at beginning of year	2008-12-31	$802,393
Value of fidelity bond covering the plan	2008-12-31	$60,000
Total contributions received or receivable from participants	2008-12-31	$51,833
Other income received	2008-12-31	$-225,992
Net income (gross income less expenses)	2008-12-31	$-161,407
Net plan assets at end of year (total assets less liabilities)	2008-12-31	$640,986
Net plan assets at beginning of year (total assets less liabilities)	2008-12-31	$802,393
Total contributions received or receivable from employer(s)	2008-12-31	$22,025
Expenses. Administrative service providers (salaries,fees and commissions)	2008-12-31	$9,273
2007 : TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2007 401k financial data
Total plan liabilities at beginning of year	2007-12-31	$554
Total income from all sources	2007-12-31	$116,939
Expenses. Total of all expenses incurred	2007-12-31	$84,902
Benefits paid (including direct rollovers)	2007-12-31	$79,733
Total plan assets at end of year	2007-12-31	$802,393
Total plan assets at beginning of year	2007-12-31	$770,910
Value of fidelity bond covering the plan	2007-12-31	$60,000
Total contributions received or receivable from participants	2007-12-31	$21,926
Other income received	2007-12-31	$47,070
Net income (gross income less expenses)	2007-12-31	$32,037
Net plan assets at end of year (total assets less liabilities)	2007-12-31	$802,393
Net plan assets at beginning of year (total assets less liabilities)	2007-12-31	$770,356
Total contributions received or receivable from employer(s)	2007-12-31	$47,943
Expenses. Administrative service providers (salaries,fees and commissions)	2007-12-31	$5,169

Form 5500 Responses for TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST

2014: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 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
2013: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: TYLERDALE FAMILY MEDICINE, PC EMPLOYEE INCENTIVE TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	TYLERDALE FAMILY MEDICINE, P.C.
Employer identification number (EIN):	251244165
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)