401k Plan data: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN plan

AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 401k Plan overview

Plan Name	AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN
Plan identification number	002

AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).
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

AGAVE SURGICAL ASSOCIATES, P.C. has sponsored the creation of one or more 401k plans.

Company Name: AGAVE SURGICAL ASSOCIATES, P.C.

Employer identification number (EIN): 860938962

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01 SHEILA PEWTROWSKI SHEILA PEWTROWSKI 2016-10-11
002 2015-01-01 SHEILA PETROWSKI SHEILA PETROWSKI 2016-10-13
002 2014-01-01 JOLYON SCHILLING JOLYON SCHILLING 2015-08-13
002 2013-01-01 JOLYON SCHILLING JOLYON SCHILLING 2014-10-14
002 2012-01-01 JOLYON SCHILLING 2013-06-06 JOLYON SCHILLING 2013-06-06
002 2011-01-01 JOLYON SCHILLING 2012-06-15 JOLYON SCHILLING 2012-06-15
002 2010-01-01 JOLYON SCHILLING 2011-06-20 JOLYON SCHILLING 2011-06-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2016-01-01	SHEILA PEWTROWSKI		SHEILA PEWTROWSKI	2016-10-11
002	2015-01-01	SHEILA PETROWSKI		SHEILA PETROWSKI	2016-10-13
002	2014-01-01	JOLYON SCHILLING		JOLYON SCHILLING	2015-08-13
002	2013-01-01	JOLYON SCHILLING		JOLYON SCHILLING	2014-10-14
002	2012-01-01	JOLYON SCHILLING	2013-06-06	JOLYON SCHILLING	2013-06-06
002	2011-01-01	JOLYON SCHILLING	2012-06-15	JOLYON SCHILLING	2012-06-15
002	2010-01-01	JOLYON SCHILLING	2011-06-20	JOLYON SCHILLING	2011-06-20

Plan Statistics for AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN

401k plan membership statisitcs for AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN

Measure Date Value
2016: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
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 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
2015: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT 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 1
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 0
Total of all active and inactive participants 2015-01-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 8
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 2
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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 12
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 1
Total of all active and inactive participants 2013-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2016: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
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	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
2015: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT 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	1
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	0
Total of all active and inactive participants	2015-01-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	8
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	2
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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	12
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	1
Total of all active and inactive participants	2013-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Financial Data on AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN

Measure	Date	Value
2016 : AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2016 401k financial data
Total income from all sources	2016-07-22	$4
Expenses. Total of all expenses incurred	2016-07-22	$176,937
Benefits paid (including direct rollovers)	2016-07-22	$176,937
Total plan assets at end of year	2016-07-22	$0
Total plan assets at beginning of year	2016-07-22	$176,933
Value of fidelity bond covering the plan	2016-07-22	$350,000
Other income received	2016-07-22	$4
Noncash contributions received	2016-07-22	$0
Net income (gross income less expenses)	2016-07-22	$-176,933
Net plan assets at end of year (total assets less liabilities)	2016-07-22	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-07-22	$176,933
Assets. Value of assets in partnership/joint-venture interests	2016-07-22	$0
2015 : AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$2,205
Expenses. Total of all expenses incurred	2015-12-31	$212,423
Benefits paid (including direct rollovers)	2015-12-31	$212,017
Total plan assets at end of year	2015-12-31	$176,933
Total plan assets at beginning of year	2015-12-31	$387,151
Value of fidelity bond covering the plan	2015-12-31	$200,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$2,205
Net income (gross income less expenses)	2015-12-31	$-210,218
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$176,933
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$387,151
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$100,000
Total contributions received or receivable from employer(s)	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$406
2014 : AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$28,286
Expenses. Total of all expenses incurred	2014-12-31	$133,382
Benefits paid (including direct rollovers)	2014-12-31	$129,880
Total plan assets at end of year	2014-12-31	$387,151
Total plan assets at beginning of year	2014-12-31	$492,247
Value of fidelity bond covering the plan	2014-12-31	$200,000
Other income received	2014-12-31	$6,936
Net income (gross income less expenses)	2014-12-31	$-105,096
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$387,151
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$492,247
Assets. Value of assets in partnership/joint-venture interests	2014-12-31	$100,000
Total contributions received or receivable from employer(s)	2014-12-31	$21,350
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$3,502
2013 : AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$-66,893
Expenses. Total of all expenses incurred	2013-12-31	$5,108
Benefits paid (including direct rollovers)	2013-12-31	$491
Total plan assets at end of year	2013-12-31	$492,247
Total plan assets at beginning of year	2013-12-31	$564,248
Value of fidelity bond covering the plan	2013-12-31	$200,000
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$-66,893
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$-72,001
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$492,247
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$564,248
Assets. Value of assets in partnership/joint-venture interests	2013-12-31	$100,000
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$4,617

Form 5500 Responses for AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN

2016: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT 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	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT 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: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
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
2013: AGAVE SURGICAL ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	AGAVE SURGICAL ASSOCIATES, P.C.
Employer identification number (EIN):	860938962
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)