401k Plan data: PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN plan

PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN 401k Plan overview

Plan Name	PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN
Plan identification number	001

PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
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.
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

PORT ORANGE INTERNISTS has sponsored the creation of one or more 401k plans.

Company Name: PORT ORANGE INTERNISTS

Employer identification number (EIN): 593292082

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01 SHAZA MOUSSLY 2020-09-17 SHAZA MOUSSLY 2020-09-17
001 2017-01-01 SHAZA MOUSSLY 2018-10-14
001 2016-01-01 SHAZA MOUSSLY 2017-10-13
001 2016-01-01 SHAZA MOUSSLY 2017-06-29
001 2015-01-01 SHAZA MOUSSLY 2016-10-17
001 2015-01-01 SHAZA MOUSSLY 2016-07-06
001 2014-01-01 SHAZAMOUSSLY
001 2014-01-01 SHAZA MOUSSLY 2015-10-14
001 2013-01-01 SHAZA MOUSSLY 2014-10-15 SHAZA MOUSSLY 2014-10-15
001 2012-01-01 SHAZA MOUSSLY 2013-10-03

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2019-01-01	SHAZA MOUSSLY	2020-09-17	SHAZA MOUSSLY	2020-09-17
001	2017-01-01	SHAZA MOUSSLY	2018-10-14
001	2016-01-01	SHAZA MOUSSLY	2017-10-13
001	2016-01-01	SHAZA MOUSSLY	2017-06-29
001	2015-01-01	SHAZA MOUSSLY	2016-10-17
001	2015-01-01	SHAZA MOUSSLY	2016-07-06
001	2014-01-01	SHAZAMOUSSLY
001	2014-01-01	SHAZA MOUSSLY	2015-10-14
001	2013-01-01	SHAZA MOUSSLY	2014-10-15	SHAZA MOUSSLY	2014-10-15
001	2012-01-01	SHAZA MOUSSLY	2013-10-03

Plan Statistics for PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN

401k plan membership statisitcs for PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN

Measure Date Value
2017: PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN 2017 401k membership
Market value of plan assets 2017-12-31 883,519
Acturial value of plan assets 2017-12-31 883,519
Funding target for retired participants and beneficiaries receiving payment 2017-12-31 0
Number of terminated vested participants 2017-12-31 0
Fundng target for terminated vested participants 2017-12-31 0
Active participant vested funding target 2017-12-31 635,762
Number of active participants 2017-12-31 3
Total funding liabilities for active participants 2017-12-31 794,703
Total participant count 2017-12-31 3
Total funding target for all participants 2017-12-31 794,703
Balance at beginning of prior year after applicable adjustments 2017-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2017-12-31 224,564
Carryover balanced portion elected for use to offset prior years funding requirement 2017-12-31 0
Prefunding balanced used to offset prior years funding requirement 2017-12-31 73,838
Amount remaining of carryover balance 2017-12-31 0
Amount remaining of prefunding balance 2017-12-31 150,726
Present value of excess contributions 2017-12-31 0
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2017-12-31 0
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2017-12-31 0
Reductions in caryover balances due to elections or deemed elections 2017-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2017-12-31 0
Balance of carryovers at beginning of current year 2017-12-31 0
Balance of prefunding at beginning of current year 2017-12-31 154,298
Total employer contributions 2017-12-31 160,000
Total employee contributions 2017-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2017-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2017-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2017-12-31 150,816
Liquidity shortfalls end of Q1 2017-12-31 0
Liquidity shortfalls end of Q2 2017-12-31 0
Liquidity shortfalls end of Q3 2017-12-31 0
Liquidity shortfalls end of Q4 2017-12-31 0
Unpaid minimum required contributions for all prior years 2017-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2017-12-31 0
Remaining amount of unpaid minimum required contributions 2017-12-31 0
Minimum required contributions for current year target normal cost 2017-12-31 597
Net shortfall amortization installment of oustanding balance 2017-12-31 80,817
Waiver amortization installment 2017-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2017-12-31 15,637
Carryover balance elected to use to offset funding requirement 2017-12-31 0
Prefunding balance elected to use to offset funding requirement 2017-12-31 0
Additional cash requirement 2017-12-31 15,637
Contributions allocatedtoward minimum required contributions for current year 2017-12-31 150,816
Unpaid minimum required contributions for current year 2017-12-31 0
Unpaid minimum required contributions for all years 2017-12-31 0
2016: PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN 2016 401k membership
Market value of plan assets 2016-12-31 756,205
Acturial value of plan assets 2016-12-31 756,205
Funding target for retired participants and beneficiaries receiving payment 2016-12-31 0
Number of terminated vested participants 2016-12-31 0
Fundng target for terminated vested participants 2016-12-31 0
Active participant vested funding target 2016-12-31 373,601
Number of active participants 2016-12-31 3
Total funding liabilities for active participants 2016-12-31 622,669
Total participant count 2016-12-31 3
Total funding target for all participants 2016-12-31 622,669
Balance at beginning of prior year after applicable adjustments 2016-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2016-12-31 219,548
Carryover balanced portion elected for use to offset prior years funding requirement 2016-12-31 0
Prefunding balanced used to offset prior years funding requirement 2016-12-31 0
Amount remaining of carryover balance 2016-12-31 0
Amount remaining of prefunding balance 2016-12-31 219,548
Present value of excess contributions 2016-12-31 8,835
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2016-12-31 9,385
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2016-12-31 9,385
Reductions in caryover balances due to elections or deemed elections 2016-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2016-12-31 0
Balance of carryovers at beginning of current year 2016-12-31 0
Balance of prefunding at beginning of current year 2016-12-31 224,564
Total employer contributions 2016-12-31 110,000
Total employee contributions 2016-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2016-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2016-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2016-12-31 102,004
Liquidity shortfalls end of Q1 2016-12-31 0
Liquidity shortfalls end of Q2 2016-12-31 0
Liquidity shortfalls end of Q3 2016-12-31 0
Liquidity shortfalls end of Q4 2016-12-31 0
Unpaid minimum required contributions for all prior years 2016-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2016-12-31 0
Remaining amount of unpaid minimum required contributions 2016-12-31 0
Minimum required contributions for current year target normal cost 2016-12-31 160,802
Net shortfall amortization installment of oustanding balance 2016-12-31 91,028
Waiver amortization installment 2016-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2016-12-31 175,842
Carryover balance elected to use to offset funding requirement 2016-12-31 0
Prefunding balance elected to use to offset funding requirement 2016-12-31 73,838
Additional cash requirement 2016-12-31 102,004
Contributions allocatedtoward minimum required contributions for current year 2016-12-31 102,004
Unpaid minimum required contributions for current year 2016-12-31 0
Unpaid minimum required contributions for all years 2016-12-31 0
2014: PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 3
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 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 4
Number of participants with account balances 2014-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2017: PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN 2017 401k membership
Market value of plan assets	2017-12-31	883,519
Acturial value of plan assets	2017-12-31	883,519
Funding target for retired participants and beneficiaries receiving payment	2017-12-31	0
Number of terminated vested participants	2017-12-31	0
Fundng target for terminated vested participants	2017-12-31	0
Active participant vested funding target	2017-12-31	635,762
Number of active participants	2017-12-31	3
Total funding liabilities for active participants	2017-12-31	794,703
Total participant count	2017-12-31	3
Total funding target for all participants	2017-12-31	794,703
Balance at beginning of prior year after applicable adjustments	2017-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2017-12-31	224,564
Carryover balanced portion elected for use to offset prior years funding requirement	2017-12-31	0
Prefunding balanced used to offset prior years funding requirement	2017-12-31	73,838
Amount remaining of carryover balance	2017-12-31	0
Amount remaining of prefunding balance	2017-12-31	150,726
Present value of excess contributions	2017-12-31	0
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2017-12-31	0
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2017-12-31	0
Reductions in caryover balances due to elections or deemed elections	2017-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2017-12-31	0
Balance of carryovers at beginning of current year	2017-12-31	0
Balance of prefunding at beginning of current year	2017-12-31	154,298
Total employer contributions	2017-12-31	160,000
Total employee contributions	2017-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2017-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2017-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2017-12-31	150,816
Liquidity shortfalls end of Q1	2017-12-31	0
Liquidity shortfalls end of Q2	2017-12-31	0
Liquidity shortfalls end of Q3	2017-12-31	0
Liquidity shortfalls end of Q4	2017-12-31	0
Unpaid minimum required contributions for all prior years	2017-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2017-12-31	0
Remaining amount of unpaid minimum required contributions	2017-12-31	0
Minimum required contributions for current year target normal cost	2017-12-31	597
Net shortfall amortization installment of oustanding balance	2017-12-31	80,817
Waiver amortization installment	2017-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2017-12-31	15,637
Carryover balance elected to use to offset funding requirement	2017-12-31	0
Prefunding balance elected to use to offset funding requirement	2017-12-31	0
Additional cash requirement	2017-12-31	15,637
Contributions allocatedtoward minimum required contributions for current year	2017-12-31	150,816
Unpaid minimum required contributions for current year	2017-12-31	0
Unpaid minimum required contributions for all years	2017-12-31	0
2016: PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN 2016 401k membership
Market value of plan assets	2016-12-31	756,205
Acturial value of plan assets	2016-12-31	756,205
Funding target for retired participants and beneficiaries receiving payment	2016-12-31	0
Number of terminated vested participants	2016-12-31	0
Fundng target for terminated vested participants	2016-12-31	0
Active participant vested funding target	2016-12-31	373,601
Number of active participants	2016-12-31	3
Total funding liabilities for active participants	2016-12-31	622,669
Total participant count	2016-12-31	3
Total funding target for all participants	2016-12-31	622,669
Balance at beginning of prior year after applicable adjustments	2016-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2016-12-31	219,548
Carryover balanced portion elected for use to offset prior years funding requirement	2016-12-31	0
Prefunding balanced used to offset prior years funding requirement	2016-12-31	0
Amount remaining of carryover balance	2016-12-31	0
Amount remaining of prefunding balance	2016-12-31	219,548
Present value of excess contributions	2016-12-31	8,835
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2016-12-31	9,385
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2016-12-31	9,385
Reductions in caryover balances due to elections or deemed elections	2016-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2016-12-31	0
Balance of carryovers at beginning of current year	2016-12-31	0
Balance of prefunding at beginning of current year	2016-12-31	224,564
Total employer contributions	2016-12-31	110,000
Total employee contributions	2016-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2016-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2016-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2016-12-31	102,004
Liquidity shortfalls end of Q1	2016-12-31	0
Liquidity shortfalls end of Q2	2016-12-31	0
Liquidity shortfalls end of Q3	2016-12-31	0
Liquidity shortfalls end of Q4	2016-12-31	0
Unpaid minimum required contributions for all prior years	2016-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2016-12-31	0
Remaining amount of unpaid minimum required contributions	2016-12-31	0
Minimum required contributions for current year target normal cost	2016-12-31	160,802
Net shortfall amortization installment of oustanding balance	2016-12-31	91,028
Waiver amortization installment	2016-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2016-12-31	175,842
Carryover balance elected to use to offset funding requirement	2016-12-31	0
Prefunding balance elected to use to offset funding requirement	2016-12-31	73,838
Additional cash requirement	2016-12-31	102,004
Contributions allocatedtoward minimum required contributions for current year	2016-12-31	102,004
Unpaid minimum required contributions for current year	2016-12-31	0
Unpaid minimum required contributions for all years	2016-12-31	0
2014: PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	3
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	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	4
Number of participants with account balances	2014-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN

Measure	Date	Value
2014 : PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$7,533
Expenses. Total of all expenses incurred	2014-12-31	$120
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$26,740
Total plan assets at beginning of year	2014-12-31	$19,327
Total contributions received or receivable from participants	2014-12-31	$7,760
Expenses. Other expenses not covered elsewhere	2014-12-31	$120
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$-227
Net income (gross income less expenses)	2014-12-31	$7,413
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$26,740
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$19,327
Assets. Value of participant loans	2014-12-31	$0
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0

Form 5500 Responses for PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN

2014: PORT ORANGE INTERNISTS, PA DEFINED BENEFIT PLAN 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 – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-832356

Policy instance

Insurance contract or identification number	GA-832356
Number of Individuals Covered	4
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

PORT ORANGE DENTIST 401(K) PLAN [EIN = 593549006]

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Company Name:	PORT ORANGE INTERNISTS
Employer identification number (EIN):	593292082
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)