401k Plan data: PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST plan

PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST
Plan identification number	001

PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 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.
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.
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

PREMIER MEDICAL CLINIC has sponsored the creation of one or more 401k plans.

Company Name: PREMIER MEDICAL CLINIC

Employer identification number (EIN): 593539240

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

Additional information about PREMIER MEDICAL CLINIC

Jurisdiction of Incorporation: California Department of State

Incorporation Date: 2012-01-11

Company Identification Number: C3443224

Legal Registered Office Address: 7360 Nada Street

Downey
United States of America (USA)
90242

More information about PREMIER MEDICAL CLINIC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01 TERESA FAULKENBERRY 2016-10-10
001 2014-01-01 TERESA FAULKENBERRY 2015-09-23
001 2013-01-01
001 2012-01-01 LAURIE SANTANA LAURIE SANTANA 2013-10-03
001 2011-01-01 LAURIE SANTANA LAURIE SANTANA 2012-10-12
001 2009-01-01 LAURIE SANTANA LAURIE SANTANA 2010-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01
001	2016-01-01
001	2015-01-01	TERESA FAULKENBERRY	2016-10-10
001	2014-01-01	TERESA FAULKENBERRY	2015-09-23
001	2013-01-01
001	2012-01-01	LAURIE SANTANA		LAURIE SANTANA	2013-10-03
001	2011-01-01	LAURIE SANTANA		LAURIE SANTANA	2012-10-12
001	2009-01-01	LAURIE SANTANA		LAURIE SANTANA	2010-10-13

Plan Statistics for PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST

Measure Date Value
2012: PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 33
Number of retired or separated participants receiving benefits 2012-01-01 2
Total of all active and inactive participants 2012-01-01 35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 35
Number of participants with account balances 2012-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 43
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 36
Number of retired or separated participants receiving benefits 2011-01-01 1
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 40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 40
Number of participants with account balances 2011-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 34
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 31
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 7
Total of all active and inactive participants 2009-01-01 38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 38
Number of participants with account balances 2009-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 2

Measure	Date	Value
2012: PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	33
Number of retired or separated participants receiving benefits	2012-01-01	2
Total of all active and inactive participants	2012-01-01	35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	35
Number of participants with account balances	2012-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	43
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	36
Number of retired or separated participants receiving benefits	2011-01-01	1
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	40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	40
Number of participants with account balances	2011-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	34
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	31
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	7
Total of all active and inactive participants	2009-01-01	38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	38
Number of participants with account balances	2009-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	2

Financial Data on PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST

Measure	Date	Value
2012 : PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$137,934
Expenses. Total of all expenses incurred	2012-12-31	$6,987
Benefits paid (including direct rollovers)	2012-12-31	$6,987
Total plan assets at end of year	2012-12-31	$643,303
Total plan assets at beginning of year	2012-12-31	$512,356
Value of fidelity bond covering the plan	2012-12-31	$265,000
Total contributions received or receivable from participants	2012-12-31	$48,149
Other income received	2012-12-31	$57,476
Net income (gross income less expenses)	2012-12-31	$130,947
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$643,303
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$512,356
Total contributions received or receivable from employer(s)	2012-12-31	$32,309
2011 : PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2011 401k financial data
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	$88,376
Expenses. Total of all expenses incurred	2011-12-31	$62,304
Benefits paid (including direct rollovers)	2011-12-31	$62,279
Total plan assets at end of year	2011-12-31	$512,356
Total plan assets at beginning of year	2011-12-31	$486,284
Value of fidelity bond covering the plan	2011-12-31	$265,000
Total contributions received or receivable from participants	2011-12-31	$62,954
Expenses. Other expenses not covered elsewhere	2011-12-31	$25
Other income received	2011-12-31	$-7,133
Net income (gross income less expenses)	2011-12-31	$26,072
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$512,356
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$486,284
Total contributions received or receivable from employer(s)	2011-12-31	$32,555
2010 : PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2010 401k financial data
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	$139,222
Expenses. Total of all expenses incurred	2010-12-31	$67,934
Benefits paid (including direct rollovers)	2010-12-31	$67,909
Total plan assets at end of year	2010-12-31	$486,284
Total plan assets at beginning of year	2010-12-31	$414,996
Value of fidelity bond covering the plan	2010-12-31	$265,000
Total contributions received or receivable from participants	2010-12-31	$63,800
Other income received	2010-12-31	$43,747
Net income (gross income less expenses)	2010-12-31	$71,288
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$486,284
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$414,996
Total contributions received or receivable from employer(s)	2010-12-31	$31,675
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$25

Form 5500 Responses for PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST

2012: PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & 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 – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
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 – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: PREMIER MEDICAL CLINIC 401(K) PROFIT SHARING PLAN & TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

LP1110328

Policy instance

Insurance contract or identification number	LP1110328
Number of Individuals Covered	20
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,800
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?	Yes
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?	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
Commission paid to Insurance Broker	USD $2,800
Insurance broker organization code?	3
Insurance broker name	HOWARD SHAPIRO

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

LP1110328

Policy instance

Insurance contract or identification number	LP1110328
Number of Individuals Covered	21
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,383
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?	Yes
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?	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

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

LP1110328

Policy instance

Insurance contract or identification number	LP1110328
Number of Individuals Covered	23
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $800
Total amount of fees paid to insurance company	USD $511
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
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?	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
Commission paid to Insurance Broker	USD $800
Amount paid for insurance broker fees	511
Additional information about fees paid to insurance broker	AUM/BTC
Insurance broker organization code?	3
Insurance broker name	HOWARD SHAPIRO

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Company Name:	PREMIER MEDICAL CLINIC
Employer identification number (EIN):	593539240
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:	2012-01-11
Company Identification Number:	C3443224
Legal Registered Office Address:	7360 Nada Street Downey United States of America (USA) 90242