401k Plan data: INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN plan

INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 401k Plan overview

Plan Name	INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN
Plan identification number	001

INTERVENTIONAL PAIN SPECIALISTS, 401(K) 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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

INTERVENTIONAL PAIN SPECIALISTS, PLLC has sponsored the creation of one or more 401k plans.

Company Name: INTERVENTIONAL PAIN SPECIALISTS, PLLC

Employer identification number (EIN): 455388396

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01 MICHAEL DIETER 2020-12-17
001 2019-01-01
001 2018-01-01
001 2017-01-01 KIM FUKE
001 2017-01-01
001 2016-01-01 CHRIS FUKE 2017-10-09 CHRIS FKE 2017-10-09
001 2015-01-01 CHRIS FUKE 2016-09-06 CHRIS FUKE 2016-09-06
001 2014-01-01 CHRIS FUJKE 2015-10-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2020-01-01	MICHAEL DIETER	2020-12-17
001	2019-01-01
001	2018-01-01
001	2017-01-01	KIM FUKE
001	2017-01-01
001	2016-01-01	CHRIS FUKE	2017-10-09	CHRIS FKE	2017-10-09
001	2015-01-01	CHRIS FUKE	2016-09-06	CHRIS FUKE	2016-09-06
001	2014-01-01	CHRIS FUJKE	2015-10-09

Plan Statistics for INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN

401k plan membership statisitcs for INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN

Measure Date Value
2019: INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 23
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 51
Total of all active and inactive participants 2019-01-01 74
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 74
Number of participants with account balances 2019-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 33
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 83
Total of all active and inactive participants 2018-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 116
Number of participants with account balances 2018-01-01 113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 91
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 48
Total of all active and inactive participants 2017-01-01 139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 139
Number of participants with account balances 2017-01-01 123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0

Measure	Date	Value
2019: INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	23
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	51
Total of all active and inactive participants	2019-01-01	74
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	74
Number of participants with account balances	2019-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	33
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	83
Total of all active and inactive participants	2018-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	116
Number of participants with account balances	2018-01-01	113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	91
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	48
Total of all active and inactive participants	2017-01-01	139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	139
Number of participants with account balances	2017-01-01	123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0

Financial Data on INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN

Measure	Date	Value
2019 : INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$498,008
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$169,401
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$164,335
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$211,968
Value of total assets at end of year	2019-12-31	$1,547,358
Value of total assets at beginning of year	2019-12-31	$1,218,751
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$5,066
Total interest from all sources	2019-12-31	$1,135
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$30,296
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$30,296
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$100,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$146,436
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$12,811
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$328,607
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,547,358
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,218,751
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,481,389
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,154,071
Interest on participant loans	2019-12-31	$0
Income. Interest from loans (other than to participants)	2019-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$65,969
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$47,668
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$47,668
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$1,135
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$254,609
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$65,532
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$4,201
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$164,335
Contract administrator fees	2019-12-31	$5,066
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Opinion of an independent qualified public accountant for this plan	2019-12-31	Qualified
Accountancy firm name	2019-12-31	TURNBULL & BRIM
Accountancy firm EIN	2019-12-31	822342025
2018 : INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$218,188
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$204,278
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$202,178
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$298,045
Value of total assets at end of year	2018-12-31	$1,218,751
Value of total assets at beginning of year	2018-12-31	$1,204,841
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$2,100
Total interest from all sources	2018-12-31	$753
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$23,946
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$23,946
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$100,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$198,268
Participant contributions at end of year	2018-12-31	$12,811
Participant contributions at beginning of year	2018-12-31	$12,221
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$13,910
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,218,751
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,204,841
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$1,154,071
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$1,175,135
Interest on participant loans	2018-12-31	$0
Income. Interest from loans (other than to participants)	2018-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$47,668
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$10,732
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$10,732
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$753
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-104,556
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$99,777
Employer contributions (assets) at end of year	2018-12-31	$4,201
Employer contributions (assets) at beginning of year	2018-12-31	$6,753
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$202,178
Contract administrator fees	2018-12-31	$2,100
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Qualified
Accountancy firm name	2018-12-31	TURNBULL & BRIM
Accountancy firm EIN	2018-12-31	822342025
2017 : INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$535,517
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$89,417
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$88,637
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$367,480
Value of total assets at end of year	2017-12-31	$1,204,841
Value of total assets at beginning of year	2017-12-31	$758,741
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$780
Total interest from all sources	2017-12-31	$105
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$20,131
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$20,131
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$100,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$221,025
Participant contributions at end of year	2017-12-31	$12,221
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$31,439
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$446,100
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,204,841
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$758,741
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$1,175,135
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$743,932
Interest on participant loans	2017-12-31	$0
Income. Interest from loans (other than to participants)	2017-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$10,732
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$14,809
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$14,809
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$105
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$147,801
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$115,016
Employer contributions (assets) at end of year	2017-12-31	$6,753
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$88,637
Contract administrator fees	2017-12-31	$780
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	VITO CINMILENIO
Accountancy firm EIN	2017-12-31	603714821

Form 5500 Responses for INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN

2019: INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: INTERVENTIONAL PAIN SPECIALISTS, 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	INTERVENTIONAL PAIN SPECIALISTS, PLLC
Employer identification number (EIN):	455388396
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)