401k Plan data: L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN plan

L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 401k Plan overview

Plan Name	L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN
Plan identification number	001

L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING 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.
Life insurance

401k Sponsoring company profile

L. WILLIAM D. NOWIERSKI, M.D., P.A. has sponsored the creation of one or more 401k plans.

Company Name: L. WILLIAM D. NOWIERSKI, M.D., P.A.

Employer identification number (EIN): 820391540

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-07-01
001 2021-07-01
001 2020-07-01
001 2019-07-01
001 2018-07-01
001 2017-07-01
001 2016-07-01
001 2015-07-01
001 2014-07-01
001 2013-07-01
001 2012-07-01 L. WILLIAM NOWIERSKI, M.D. 2013-12-18 L. WILLIAM NOWIERSKI, M.D. 2013-12-18
001 2011-07-01 L WILLIAM D NOWIERSKI MD
001 2010-07-01 L WILLIAM D NOWIERSKI MD
001 2009-07-01 L WILLIAM D NOWIERSKI MD
001 2009-07-01 L WILLIAM D NOWIERSKI MD

Plan Statistics for L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN

401k plan membership statisitcs for L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN

Measure Date Value
2011: L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-07-01 5
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 5
Total of all active and inactive participants 2011-07-01 5
Total participants 2011-07-01 5
Number of participants with account balances 2011-07-01 5
2010: L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 5
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 5
Total of all active and inactive participants 2010-07-01 5
Total participants 2010-07-01 5
Number of participants with account balances 2010-07-01 5
2009: L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-07-01 4
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 5
Total of all active and inactive participants 2009-07-01 5
Total participants 2009-07-01 5
Number of participants with account balances 2009-07-01 5

Measure	Date	Value
2011: L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-07-01	5
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	5
Total of all active and inactive participants	2011-07-01	5
Total participants	2011-07-01	5
Number of participants with account balances	2011-07-01	5
2010: L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	5
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	5
Total of all active and inactive participants	2010-07-01	5
Total participants	2010-07-01	5
Number of participants with account balances	2010-07-01	5
2009: L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-07-01	4
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	5
Total of all active and inactive participants	2009-07-01	5
Total participants	2009-07-01	5
Number of participants with account balances	2009-07-01	5

Financial Data on L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN

Measure	Date	Value
2012 : L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-06-30	$19,973
Total plan assets at end of year	2012-06-30	$409,975
Total plan assets at beginning of year	2012-06-30	$390,002
Value of fidelity bond covering the plan	2012-06-30	$40,000
Other income received	2012-06-30	$1,120
Net income (gross income less expenses)	2012-06-30	$19,973
Net plan assets at end of year (total assets less liabilities)	2012-06-30	$409,975
Net plan assets at beginning of year (total assets less liabilities)	2012-06-30	$390,002
Total contributions received or receivable from employer(s)	2012-06-30	$18,853
2011 : L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-06-30	$60,990
Total plan assets at end of year	2011-06-30	$390,002
Total plan assets at beginning of year	2011-06-30	$329,012
Value of fidelity bond covering the plan	2011-06-30	$40,000
Other income received	2011-06-30	$52,810
Net income (gross income less expenses)	2011-06-30	$60,990
Net plan assets at end of year (total assets less liabilities)	2011-06-30	$390,002
Net plan assets at beginning of year (total assets less liabilities)	2011-06-30	$329,012
Total contributions received or receivable from employer(s)	2011-06-30	$8,180

Form 5500 Responses for L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN

2011: L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2010: L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan funding arrangement – Trust	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement - Trust	Yes
2009: L. WILLIAM D. NOWIERSKI, M.D., P.A. PROFIT SHARING PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )

Policy contract number

2 742 590

Policy instance

Insurance contract or identification number	2 742 590
Number of Individuals Covered	1
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Are there contracts with allocated funds for individual policies?	Yes
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )

Policy contract number

2 742 590

Policy instance

Insurance contract or identification number	2 742 590
Number of Individuals Covered	1
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Are there contracts with allocated funds for individual policies?	Yes
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

L. WILLIAM ROBERTS, MD, PSC RETIREMENT SAVINGS PLA [EIN = 610985753]

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Company Name:	L. WILLIAM D. NOWIERSKI, M.D., P.A.
Employer identification number (EIN):	820391540
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-07-01
001	2021-07-01
001	2020-07-01
001	2019-07-01
001	2018-07-01
001	2017-07-01
001	2016-07-01
001	2015-07-01
001	2014-07-01
001	2013-07-01
001	2012-07-01	L. WILLIAM NOWIERSKI, M.D.	2013-12-18	L. WILLIAM NOWIERSKI, M.D.	2013-12-18
001	2011-07-01	L WILLIAM D NOWIERSKI MD
001	2010-07-01	L WILLIAM D NOWIERSKI MD
001	2009-07-01	L WILLIAM D NOWIERSKI MD
001	2009-07-01	L WILLIAM D NOWIERSKI MD