401k Plan data: CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN plan

CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN 401k Plan overview

Plan Name	CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN
Plan identification number	001

CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS 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.
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

CHIPPS, CAFFREY, & DUBILIER P.S.C. has sponsored the creation of one or more 401k plans.

Company Name: CHIPPS, CAFFREY, & DUBILIER P.S.C.

Employer identification number (EIN): 610714497

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN

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 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01
001 2013-01-01
001 2012-01-01 MICHAEL S. GRAFF 2013-10-11
001 2011-01-01 MICHAEL S. GRAFF 2012-10-15
001 2010-01-01 TERRY CLARK 2011-10-17

Plan Statistics for CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN

401k plan membership statisitcs for CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN

Measure Date Value
2022: CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 102
Number of retired or separated participants receiving benefits 2022-01-01 1
Number of other retired or separated participants entitled to future benefits 2022-01-01 33
Total of all active and inactive participants 2022-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 1
Total participants 2022-01-01 137
Number of participants with account balances 2022-01-01 136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 11
2021: CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 100
Number of retired or separated participants receiving benefits 2021-01-01 1
Number of other retired or separated participants entitled to future benefits 2021-01-01 20
Total of all active and inactive participants 2021-01-01 121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 121
Number of participants with account balances 2021-01-01 120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 9

Measure	Date	Value
2022: CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	102
Number of retired or separated participants receiving benefits	2022-01-01	1
Number of other retired or separated participants entitled to future benefits	2022-01-01	33
Total of all active and inactive participants	2022-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	1
Total participants	2022-01-01	137
Number of participants with account balances	2022-01-01	136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	11
2021: CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	100
Number of retired or separated participants receiving benefits	2021-01-01	1
Number of other retired or separated participants entitled to future benefits	2021-01-01	20
Total of all active and inactive participants	2021-01-01	121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	121
Number of participants with account balances	2021-01-01	120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	9

Financial Data on CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN

Measure	Date	Value
2022 : CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN 2022 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$4
Total income from all sources (including contributions)	2022-12-31	$-1,661,513
Total of all expenses incurred	2022-12-31	$437,312
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$367,026
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,335,871
Value of total assets at end of year	2022-12-31	$17,045,528
Value of total assets at beginning of year	2022-12-31	$19,144,357
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$70,286
Total interest from all sources	2022-12-31	$1,490
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$554,688
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$554,688
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$563,767
Participant contributions at end of year	2022-12-31	$45,841
Participant contributions at beginning of year	2022-12-31	$44,321
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$3,777,381
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$4,576,994
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$4
Other income not declared elsewhere	2022-12-31	$-735,630
Administrative expenses (other) incurred	2022-12-31	$1,398
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-2,098,825
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$17,045,528
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$19,144,353
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$12,148,275
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$14,274,840
Interest on participant loans	2022-12-31	$1,490
Value of interest in common/collective trusts at end of year	2022-12-31	$1,012,187
Value of interest in common/collective trusts at beginning of year	2022-12-31	$85,241
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-2,817,932
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$772,104
Employer contributions (assets) at end of year	2022-12-31	$61,844
Employer contributions (assets) at beginning of year	2022-12-31	$162,961
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$367,026
Contract administrator fees	2022-12-31	$68,888
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	DEAN DORTON ALLEN FORD, PLLC
Accountancy firm EIN	2022-12-31	273858252
2021 : CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$4
Total income from all sources (including contributions)	2021-12-31	$3,862,546
Total of all expenses incurred	2021-12-31	$3,434,772
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$3,371,468
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$1,298,984
Value of total assets at end of year	2021-12-31	$19,144,357
Value of total assets at beginning of year	2021-12-31	$18,716,579
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$63,304
Total interest from all sources	2021-12-31	$2,423
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$683,803
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$683,803
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$508,080
Participant contributions at end of year	2021-12-31	$44,321
Participant contributions at beginning of year	2021-12-31	$78,594
Participant contributions at beginning of year	2021-12-31	$16,662
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$4,576,994
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$5,288,357
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$4
Other income not declared elsewhere	2021-12-31	$743,517
Administrative expenses (other) incurred	2021-12-31	$3,074
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$427,774
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$19,144,353
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$18,716,579
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$14,274,840
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$10,636,683
Interest on participant loans	2021-12-31	$2,423
Value of interest in common/collective trusts at end of year	2021-12-31	$85,241
Value of interest in common/collective trusts at beginning of year	2021-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$2,343,735
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$1,133,819
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$790,904
Employer contributions (assets) at end of year	2021-12-31	$162,961
Employer contributions (assets) at beginning of year	2021-12-31	$352,548
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$3,371,468
Contract administrator fees	2021-12-31	$60,230
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	Yes
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	DEAN DORTON
Accountancy firm EIN	2021-12-31	273858252

Form 5500 Responses for CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN

2022: CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: CHIPPS, CAFFREY & DUBILIER, P.S.C. PROFIT SHARING AND SAVINGS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

81G817

Policy instance

Insurance contract or identification number	81G817
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,780
Total amount of fees paid to insurance company	USD $2,926
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,780
Insurance broker organization code?	7
Amount paid for insurance broker fees	2926
Additional information about fees paid to insurance broker	TPA FEES

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

GH3473

Policy instance

Insurance contract or identification number	GH3473
Number of Individuals Covered	0
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,245
Total amount of fees paid to insurance company	USD $2,080
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,245
Insurance broker organization code?	7
Amount paid for insurance broker fees	2080
Additional information about fees paid to insurance broker	TPA FEES

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Company Name:	CHIPPS, CAFFREY, & DUBILIER P.S.C.
Employer identification number (EIN):	610714497
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2018-01-01
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01
001	2013-01-01
001	2012-01-01	MICHAEL S. GRAFF	2013-10-11
001	2011-01-01	MICHAEL S. GRAFF	2012-10-15
001	2010-01-01	TERRY CLARK	2011-10-17