401k Plan data: TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN plan

TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN 401k Plan overview

Plan Name	TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN
Plan identification number	002

TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN Benefits

401k Plan Type

Defined 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.
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.
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

TRI-STATE ORTHOPEDIC INSTITUTE, P.C. has sponsored the creation of one or more 401k plans.

Company Name: TRI-STATE ORTHOPEDIC INSTITUTE, P.C.

Employer identification number (EIN): 860729474

NAIC Classification: 621112
NAIC Description: Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01
002 2016-01-01 BLAKE A. STAMPER, DO 2017-10-02
002 2015-01-01 BLAKE A. STAMPER, DO 2016-10-03
002 2014-01-01 BLAKE A. STAMPER, DO 2015-07-08
002 2013-01-01 BLAKE A. STAMPER, DO 2014-09-19
002 2012-01-01 BLAKE A. STAMPER, DO 2013-09-25
002 2011-01-01 BLAKE A. STAMPER, DO
002 2009-01-01 BLAKE A. STAMPER, DO
002 2009-01-01 BLAKE A. STAMPER, DO
002 2009-01-01 BLAKE A. STAMPER, DO

Plan Statistics for TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN

401k plan membership statisitcs for TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN

Measure Date Value
2011: TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 14
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 17
Total participants 2011-01-01 17
Number of participants with account balances 2011-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 18
Number of other retired or separated participants entitled to future benefits 2009-01-01 10
Total of all active and inactive participants 2009-01-01 28
Total participants 2009-01-01 28
Number of participants with account balances 2009-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 4

Measure	Date	Value
2011: TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	14
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	17
Total participants	2011-01-01	17
Number of participants with account balances	2011-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	18
Number of other retired or separated participants entitled to future benefits	2009-01-01	10
Total of all active and inactive participants	2009-01-01	28
Total participants	2009-01-01	28
Number of participants with account balances	2009-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	4

Financial Data on TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN

Measure	Date	Value
2011 : TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$72,295
Expenses. Total of all expenses incurred	2011-12-31	$914,555
Benefits paid (including direct rollovers)	2011-12-31	$897,419
Total plan assets at end of year	2011-12-31	$1,517,209
Total plan assets at beginning of year	2011-12-31	$2,359,469
Value of fidelity bond covering the plan	2011-12-31	$645,000
Total contributions received or receivable from participants	2011-12-31	$56,366
Other income received	2011-12-31	$-69,319
Net income (gross income less expenses)	2011-12-31	$-842,260
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,517,209
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,359,469
Total contributions received or receivable from employer(s)	2011-12-31	$85,248
Value of corrective distributions	2011-12-31	$1,368
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$15,768
2010 : TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$467,951
Expenses. Total of all expenses incurred	2010-12-31	$121,877
Benefits paid (including direct rollovers)	2010-12-31	$107,107
Total plan assets at end of year	2010-12-31	$2,359,469
Total plan assets at beginning of year	2010-12-31	$2,013,395
Value of fidelity bond covering the plan	2010-12-31	$300,000
Total contributions received or receivable from participants	2010-12-31	$56,272
Expenses. Other expenses not covered elsewhere	2010-12-31	$1,342
Other income received	2010-12-31	$336,655
Net income (gross income less expenses)	2010-12-31	$346,074
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,359,469
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,013,395
Total contributions received or receivable from employer(s)	2010-12-31	$75,024
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$13,428

Form 5500 Responses for TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN

2011: TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
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: TRI-STATE ORTHOPEDIC INSTITUTE 401K PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
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

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

65838

Policy instance

Insurance contract or identification number	65838
Number of Individuals Covered	13
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,357
Total amount of fees paid to insurance company	USD $750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

65838

Policy instance

Insurance contract or identification number	65838
Number of Individuals Covered	15
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,658
Total amount of fees paid to insurance company	USD $1,560
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,658
Insurance broker organization code?	4
Amount paid for insurance broker fees	1560
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION
Insurance broker name	BOYCE & ASSOCIATES, INC.

Potentially related plans

TRI-STATE ORTHOPEDIC PRODUCTS, INC. 401(K) PROFIT SHARING PLAN [EIN = 753038334]

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Company Name:	TRI-STATE ORTHOPEDIC INSTITUTE, P.C.
Employer identification number (EIN):	860729474
NAIC Classification:	621112
NAIC Description:	Offices of Physicians, Mental Health Specialists

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01
002	2016-01-01	BLAKE A. STAMPER, DO	2017-10-02
002	2015-01-01	BLAKE A. STAMPER, DO	2016-10-03
002	2014-01-01	BLAKE A. STAMPER, DO	2015-07-08
002	2013-01-01	BLAKE A. STAMPER, DO	2014-09-19
002	2012-01-01	BLAKE A. STAMPER, DO	2013-09-25
002	2011-01-01	BLAKE A. STAMPER, DO
002	2009-01-01	BLAKE A. STAMPER, DO
002	2009-01-01	BLAKE A. STAMPER, DO
002	2009-01-01	BLAKE A. STAMPER, DO