401k Plan data: PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN plan

PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN 401k Plan overview

Plan Name	PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN
Plan identification number	001

PALM HARBOR PEDIATRICS, P.A. 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.
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

PALM HARBOR PEDIATRICS, P.A. has sponsored the creation of one or more 401k plans.

Company Name: PALM HARBOR PEDIATRICS, P.A.

Employer identification number (EIN): 592922707

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

Additional information about PALM HARBOR PEDIATRICS, P.A.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1989-01-09

Company Identification Number: K56807

Legal Registered Office Address: 2595 S.R. 584

PALM HARBOR

34684

More information about PALM HARBOR PEDIATRICS, P.A.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-11-01 ENID GAUD 2015-07-20
001 2013-11-01 ENID GAUD 2015-06-12
001 2012-11-01 ENID GAUD 2014-04-02
001 2011-11-01 ENID GAUD 2013-01-09
001 2010-11-01 ENID GAUD 2012-04-27
001 2008-11-01 ENID GAUD

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2014-11-01	ENID GAUD	2015-07-20
001	2013-11-01	ENID GAUD	2015-06-12
001	2012-11-01	ENID GAUD	2014-04-02
001	2011-11-01	ENID GAUD	2013-01-09
001	2010-11-01	ENID GAUD	2012-04-27
001	2008-11-01	ENID GAUD

Plan Statistics for PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN

401k plan membership statisitcs for PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN

Measure Date Value
2008: PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN 2008 401k membership
Total participants, beginning-of-year 2008-11-01 8
Total number of active participants reported on line 7a of the Form 5500 2008-11-01 8
Number of retired or separated participants receiving benefits 2008-11-01 0
Number of other retired or separated participants entitled to future benefits 2008-11-01 1
Total of all active and inactive participants 2008-11-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2008-11-01 0
Total participants 2008-11-01 9
Number of participants with account balances 2008-11-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2008-11-01 0

Measure	Date	Value
2008: PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN 2008 401k membership
Total participants, beginning-of-year	2008-11-01	8
Total number of active participants reported on line 7a of the Form 5500	2008-11-01	8
Number of retired or separated participants receiving benefits	2008-11-01	0
Number of other retired or separated participants entitled to future benefits	2008-11-01	1
Total of all active and inactive participants	2008-11-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2008-11-01	0
Total participants	2008-11-01	9
Number of participants with account balances	2008-11-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2008-11-01	0

Financial Data on PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN

Measure	Date	Value
2009 : PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN 2009 401k financial data
Total plan liabilities at end of year	2009-10-31	$0
Total plan liabilities at beginning of year	2009-10-31	$0
Total income from all sources	2009-10-31	$31,545
Expenses. Total of all expenses incurred	2009-10-31	$180
Total plan assets at end of year	2009-10-31	$122,302
Total plan assets at beginning of year	2009-10-31	$90,937
Value of fidelity bond covering the plan	2009-10-31	$50,000
Total contributions received or receivable from participants	2009-10-31	$7,639
Other income received	2009-10-31	$16,500
Net income (gross income less expenses)	2009-10-31	$31,365
Net plan assets at end of year (total assets less liabilities)	2009-10-31	$122,302
Net plan assets at beginning of year (total assets less liabilities)	2009-10-31	$90,937
Total contributions received or receivable from employer(s)	2009-10-31	$7,406
Expenses. Administrative service providers (salaries,fees and commissions)	2009-10-31	$180

Form 5500 Responses for PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN

2008: PALM HARBOR PEDIATRICS, P.A. 401(K) PLAN 2008 form 5500 responses
2008-11-01	Type of plan entity	Single employer plan
2008-11-01	Submission has been amended	Yes
2008-11-01	This submission is the final filing	No
2008-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-11-01	Plan is a collectively bargained plan	No
2008-11-01	Plan funding arrangement – Insurance	Yes
2008-11-01	Plan funding arrangement – Trust	Yes
2008-11-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

25788

Policy instance

Insurance contract or identification number	25788
Number of Individuals Covered	9
Insurance policy start date	2008-11-01
Insurance policy end date	2009-10-31
Total amount of commissions paid to insurance broker	USD $479
Total amount of fees paid to insurance company	USD $40
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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

Potentially related plans

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Company Name:	PALM HARBOR PEDIATRICS, P.A.
Employer identification number (EIN):	592922707
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1989-01-09
Company Identification Number:	K56807
Legal Registered Office Address:	2595 S.R. 584 PALM HARBOR 34684