401k Plan data: PILCHUCK VETERINARY HOSPITAL 401(K) PLAN plan

PILCHUCK VETERINARY HOSPITAL 401(K) PLAN 401k Plan overview

Plan Name	PILCHUCK VETERINARY HOSPITAL 401(K) PLAN
Plan identification number	001

PILCHUCK VETERINARY HOSPITAL 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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

PILCHUCK VETERINARY HOSPITAL, INC. P.S. has sponsored the creation of one or more 401k plans.

Company Name: PILCHUCK VETERINARY HOSPITAL, INC. P.S.

Employer identification number (EIN): 911665056

NAIC Classification: 541940
NAIC Description: Veterinary Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PILCHUCK VETERINARY HOSPITAL 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01 LYNN BLEVINS 2018-07-19
001 2016-01-01 LYNN BLEVINS 2017-09-21
001 2015-01-01 LYNN BLEVINS 2016-08-30
001 2014-01-01 LYNN BLEVINS 2015-09-24
001 2013-01-01 LYNN BLEVINS 2014-10-06
001 2012-01-01 LYNN BLEVINS 2013-07-09
001 2011-01-01 CARA BLEVINS
001 2010-01-01 JAMES F. MCCUTCHAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2017-01-01	LYNN BLEVINS	2018-07-19
001	2016-01-01	LYNN BLEVINS	2017-09-21
001	2015-01-01	LYNN BLEVINS	2016-08-30
001	2014-01-01	LYNN BLEVINS	2015-09-24
001	2013-01-01	LYNN BLEVINS	2014-10-06
001	2012-01-01	LYNN BLEVINS	2013-07-09
001	2011-01-01	CARA BLEVINS
001	2010-01-01	JAMES F. MCCUTCHAN

Plan Statistics for PILCHUCK VETERINARY HOSPITAL 401(K) PLAN

401k plan membership statisitcs for PILCHUCK VETERINARY HOSPITAL 401(K) PLAN

Measure Date Value
2011: PILCHUCK VETERINARY HOSPITAL 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 118
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 28
Total of all active and inactive participants 2011-01-01 146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 146
Number of participants with account balances 2011-01-01 101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 8
2010: PILCHUCK VETERINARY HOSPITAL 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 109
Number of retired or separated participants receiving benefits 2010-01-01 4
Number of other retired or separated participants entitled to future benefits 2010-01-01 19
Total of all active and inactive participants 2010-01-01 132
Total participants 2010-01-01 132
Number of participants with account balances 2010-01-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 3

Measure	Date	Value
2011: PILCHUCK VETERINARY HOSPITAL 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	118
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	28
Total of all active and inactive participants	2011-01-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	146
Number of participants with account balances	2011-01-01	101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	8
2010: PILCHUCK VETERINARY HOSPITAL 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	109
Number of retired or separated participants receiving benefits	2010-01-01	4
Number of other retired or separated participants entitled to future benefits	2010-01-01	19
Total of all active and inactive participants	2010-01-01	132
Total participants	2010-01-01	132
Number of participants with account balances	2010-01-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	3

Financial Data on PILCHUCK VETERINARY HOSPITAL 401(K) PLAN

Measure	Date	Value
2011 : PILCHUCK VETERINARY HOSPITAL 401(K) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$11,574
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$565,190
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$130,774
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$111,102
Value of total corrective distributions	2011-12-31	$5,647
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$345,794
Value of total assets at end of year	2011-12-31	$2,203,358
Value of total assets at beginning of year	2011-12-31	$1,757,368
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$14,025
Total interest from all sources	2011-12-31	$1,011
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$200,000
If this is an individual account plan, was there a blackout period	2011-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$289,604
Participant contributions at end of year	2011-12-31	$32,431
Participant contributions at beginning of year	2011-12-31	$13,323
Participant contributions at end of year	2011-12-31	$21,236
Participant contributions at beginning of year	2011-12-31	$16,689
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$15,801
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$655
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$11,574
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$434,416
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$2,191,784
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,757,368
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$1,724,156
Value of interest in pooled separate accounts at end of year	2011-12-31	$2,146,746
Interest on participant loans	2011-12-31	$1,011
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$92,178
Net investment gain/loss from pooled separate accounts	2011-12-31	$126,207
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2011-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$40,389
Employer contributions (assets) at end of year	2011-12-31	$2,945
Employer contributions (assets) at beginning of year	2011-12-31	$2,545
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$111,102
Contract administrator fees	2011-12-31	$14,025
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-12-31	Yes
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	WORTHY & COMPANY, LLC
Accountancy firm EIN	2011-12-31	208092242
2010 : PILCHUCK VETERINARY HOSPITAL 401(K) PLAN 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$405,065
Total of all expenses incurred	2010-12-31	$204,195
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$199,017
Expenses. Certain deemed distributions of participant loans	2010-12-31	$4,928
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$256,556
Value of total assets at end of year	2010-12-31	$1,757,368
Value of total assets at beginning of year	2010-12-31	$1,556,498
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$250
Total interest from all sources	2010-12-31	$1,739
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$50,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$222,659
Participant contributions at end of year	2010-12-31	$13,323
Participant contributions at beginning of year	2010-12-31	$37,877
Participant contributions at end of year	2010-12-31	$16,689
Participant contributions at beginning of year	2010-12-31	$13,659
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$655
Administrative expenses (other) incurred	2010-12-31	$250
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$200,870
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,757,368
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$1,556,498
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$1,724,156
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$1,502,703
Interest on participant loans	2010-12-31	$1,739
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$146,770
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$33,897
Employer contributions (assets) at end of year	2010-12-31	$2,545
Employer contributions (assets) at beginning of year	2010-12-31	$2,259
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$199,017
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	WORTHY & COMPANY, LLC
Accountancy firm EIN	2010-12-31	208092242

Form 5500 Responses for PILCHUCK VETERINARY HOSPITAL 401(K) PLAN

2011: PILCHUCK VETERINARY HOSPITAL 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
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
2010: PILCHUCK VETERINARY HOSPITAL 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

RM 85541-1

Policy instance

Insurance contract or identification number	RM 85541-1
Number of Individuals Covered	108
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $25,994
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	PILCHUCK VETERINARY HOSPITAL, INC. P.S.
Employer identification number (EIN):	911665056
NAIC Classification:	541940
NAIC Description:	Veterinary Services