401k Plan data: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN plan

THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 401k Plan overview

Plan Name	THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN
Plan identification number	001

THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 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.
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.

401k Sponsoring company profile

THEODORE E. STAAHL, M.D. has sponsored the creation of one or more 401k plans.

Company Name: THEODORE E. STAAHL, M.D.

Employer identification number (EIN): 770392240

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) 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 THEODORE STAAHL 2019-09-08 THEODORE STAAHL 2019-09-08
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01
001 2014-01-01
001 2013-01-01
001 2012-01-01 MARTHA TALAMANTES 2013-10-09
001 2011-01-01 THEODORE STAAHL 2012-10-12 THEODORE STAAHL 2012-10-12
001 2010-01-01 THEODORE E. STAAHL,M.D.,INC. 2011-10-10 THEODORE E. STAAHL, M.D., INC. 2011-10-10

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	THEODORE STAAHL	2019-09-08	THEODORE STAAHL	2019-09-08
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01
001	2014-01-01
001	2013-01-01
001	2012-01-01	MARTHA TALAMANTES	2013-10-09
001	2011-01-01	THEODORE STAAHL	2012-10-12	THEODORE STAAHL	2012-10-12
001	2010-01-01	THEODORE E. STAAHL,M.D.,INC.	2011-10-10	THEODORE E. STAAHL, M.D., INC.	2011-10-10

Plan Statistics for THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN

401k plan membership statisitcs for THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN

Measure Date Value
2018: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 7
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 2
Total of all active and inactive participants 2018-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 9
Number of participants with account balances 2018-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 7
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 3
Total of all active and inactive participants 2017-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 10
Number of participants with account balances 2017-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 7
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 3
Total of all active and inactive participants 2016-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 10
Number of participants with account balances 2016-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 7
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 3
Total of all active and inactive participants 2015-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 10
Number of participants with account balances 2015-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 7
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 3
Total of all active and inactive participants 2014-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 10
Number of participants with account balances 2014-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2018: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	7
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	2
Total of all active and inactive participants	2018-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	9
Number of participants with account balances	2018-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	7
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	3
Total of all active and inactive participants	2017-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	10
Number of participants with account balances	2017-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	7
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	3
Total of all active and inactive participants	2016-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	10
Number of participants with account balances	2016-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	7
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	3
Total of all active and inactive participants	2015-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	10
Number of participants with account balances	2015-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	7
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	3
Total of all active and inactive participants	2014-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	10
Number of participants with account balances	2014-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN

Measure	Date	Value
2018 : THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$39,212
Expenses. Total of all expenses incurred	2018-12-31	$92,960
Benefits paid (including direct rollovers)	2018-12-31	$92,810
Total plan assets at end of year	2018-12-31	$519,568
Total plan assets at beginning of year	2018-12-31	$573,316
Value of fidelity bond covering the plan	2018-12-31	$250,000
Total contributions received or receivable from participants	2018-12-31	$30,817
Assets. Value of loans (other than to participants)	2018-12-31	$210,000
Other income received	2018-12-31	$-3,711
Net income (gross income less expenses)	2018-12-31	$-53,748
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$519,568
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$573,316
Assets. Value of assets in partnership/joint-venture interests	2018-12-31	$5,000
Total contributions received or receivable from employer(s)	2018-12-31	$12,106
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$150
2017 : THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$52,474
Expenses. Total of all expenses incurred	2017-12-31	$10,069
Benefits paid (including direct rollovers)	2017-12-31	$10,069
Total plan assets at end of year	2017-12-31	$573,316
Total plan assets at beginning of year	2017-12-31	$530,911
Value of fidelity bond covering the plan	2017-12-31	$250,000
Total contributions received or receivable from participants	2017-12-31	$30,742
Assets. Value of loans (other than to participants)	2017-12-31	$210,000
Other income received	2017-12-31	$12,414
Net income (gross income less expenses)	2017-12-31	$42,405
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$573,316
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$530,911
Assets. Value of assets in partnership/joint-venture interests	2017-12-31	$5,000
Total contributions received or receivable from employer(s)	2017-12-31	$9,318
2016 : THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$40,297
Expenses. Total of all expenses incurred	2016-12-31	$24,600
Benefits paid (including direct rollovers)	2016-12-31	$24,600
Total plan assets at end of year	2016-12-31	$530,911
Total plan assets at beginning of year	2016-12-31	$515,214
Value of fidelity bond covering the plan	2016-12-31	$250,000
Total contributions received or receivable from participants	2016-12-31	$27,889
Assets. Value of loans (other than to participants)	2016-12-31	$210,000
Other income received	2016-12-31	$-145
Net income (gross income less expenses)	2016-12-31	$15,697
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$530,911
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$515,214
Assets. Value of assets in partnership/joint-venture interests	2016-12-31	$5,000
Total contributions received or receivable from employer(s)	2016-12-31	$12,553
2015 : THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$-113,221
Expenses. Total of all expenses incurred	2015-12-31	$8,468
Benefits paid (including direct rollovers)	2015-12-31	$8,443
Total plan assets at end of year	2015-12-31	$515,214
Total plan assets at beginning of year	2015-12-31	$636,903
Value of fidelity bond covering the plan	2015-12-31	$130,000
Total contributions received or receivable from participants	2015-12-31	$30,773
Assets. Value of loans (other than to participants)	2015-12-31	$210,000
Expenses. Other expenses not covered elsewhere	2015-12-31	$25
Other income received	2015-12-31	$-156,793
Net income (gross income less expenses)	2015-12-31	$-121,689
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$515,214
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$636,903
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$5,000
Total contributions received or receivable from employer(s)	2015-12-31	$12,799
2014 : THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$-567,171
Total plan assets at end of year	2014-12-31	$636,903
Total plan assets at beginning of year	2014-12-31	$1,204,074
Value of fidelity bond covering the plan	2014-12-31	$130,000
Total contributions received or receivable from participants	2014-12-31	$21,816
Assets. Value of loans (other than to participants)	2014-12-31	$210,000
Other income received	2014-12-31	$-600,045
Net income (gross income less expenses)	2014-12-31	$-567,171
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$636,903
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,204,074
Assets. Value of assets in partnership/joint-venture interests	2014-12-31	$150,000
Total contributions received or receivable from employer(s)	2014-12-31	$11,058

Form 5500 Responses for THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN

2018: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: THEODORE E. STAAHL, M.D., INC. PROFIT SHARING 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	THEODORE E. STAAHL, M.D.
Employer identification number (EIN):	770392240
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)