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UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameUPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN
Plan identification number 001

UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC has sponsored the creation of one or more 401k plans.

Company Name:UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC
Employer identification number (EIN):621718402
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012024-01-01MARK KRISKOVICH
0012023-01-01
0012023-01-01MIKE VAUGHN
0012022-01-01MICHAEL VAUGHN2023-09-05
0012021-01-01MICHAEL VAUGHN2022-07-11
0012020-01-01MICHAEL VAUGHN2021-10-11
0012019-01-01MICHAEL VAUGHN2020-10-15
0012018-01-01MICHAEL VAUGHN2019-08-30
0012017-01-01MICHAEL VAUGHN2018-10-11
0012016-01-01MICHAEL VAUGHN2017-06-30
0012015-01-01MICHAEL VAUGHN2016-10-03
0012014-01-01MICHAEL VAUGHN2015-07-28
0012013-01-01MICHAEL VAUGHN2014-08-01
0012012-01-01FREDERICK RAYNE2013-07-18
0012011-01-01BRONN RAYNE BRONN RAYNE2012-07-26
0012010-01-01BRONN RAYNE BRONN RAYNE2011-07-21
0012009-01-01BRONN RAYNE BRONN RAYNE2010-07-26

Financial Data on UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN

Measure Date Value
2023 : UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN 2023 401k financial data
Transfers to/from the plan2023-12-31$0
Total plan liabilities at end of year2023-12-31$0
Total plan liabilities at beginning of year2023-12-31$0
Total income from all sources2023-12-31$738,365
Expenses. Total of all expenses incurred2023-12-31$1,830,142
Benefits paid (including direct rollovers)2023-12-31$1,829,944
Total plan assets at end of year2023-12-31$3,643,663
Total plan assets at beginning of year2023-12-31$4,735,440
Value of fidelity bond covering the plan2023-12-31$500,000
Total contributions received or receivable from participants2023-12-31$143,671
Expenses. Other expenses not covered elsewhere2023-12-31$0
Contributions received from other sources (not participants or employers)2023-12-31$0
Other income received2023-12-31$513,849
Noncash contributions received2023-12-31$0
Net income (gross income less expenses)2023-12-31$-1,091,777
Net plan assets at end of year (total assets less liabilities)2023-12-31$3,643,663
Net plan assets at beginning of year (total assets less liabilities)2023-12-31$4,735,440
Total contributions received or receivable from employer(s)2023-12-31$80,845
Value of certain deemed distributions of participant loans2023-12-31$0
Value of corrective distributions2023-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2023-12-31$198
2011 : UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$227,246
Expenses. Total of all expenses incurred2011-12-31$480,094
Benefits paid (including direct rollovers)2011-12-31$479,624
Total plan assets at end of year2011-12-31$3,926,079
Total plan assets at beginning of year2011-12-31$4,178,927
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$133,188
Expenses. Other expenses not covered elsewhere2011-12-31$470
Other income received2011-12-31$-54,575
Net income (gross income less expenses)2011-12-31$-252,848
Net plan assets at end of year (total assets less liabilities)2011-12-31$3,926,079
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$4,178,927
Total contributions received or receivable from employer(s)2011-12-31$148,633
2010 : UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources2010-12-31$768,386
Expenses. Total of all expenses incurred2010-12-31$129,057
Benefits paid (including direct rollovers)2010-12-31$128,566
Total plan assets at end of year2010-12-31$4,178,927
Total plan assets at beginning of year2010-12-31$3,539,598
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$135,571
Expenses. Other expenses not covered elsewhere2010-12-31$491
Contributions received from other sources (not participants or employers)2010-12-31$208,627
Other income received2010-12-31$276,591
Net income (gross income less expenses)2010-12-31$639,329
Net plan assets at end of year (total assets less liabilities)2010-12-31$4,178,927
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$3,539,598
Total contributions received or receivable from employer(s)2010-12-31$147,597

Form 5500 Responses for UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN

2023: UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – TrustYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement - TrustYes
2011: UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: UPPER CUMBERLAND OTOLARYNGOLOGY CLINIC, PC 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number897643 087
Policy instance 1
Insurance contract or identification number897643 087
Number of Individuals Covered1
Insurance policy start date2023-09-01
Insurance policy end date2023-12-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number79680001
Policy instance 2
Insurance contract or identification number79680001
Number of Individuals Covered0
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
MONY LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 66370 )
Policy contract number9169100
Policy instance 1
MONY LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 66370 )
Policy contract number9169100
Policy instance 1

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