401k Plan data: URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN plan

URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN 401k Plan overview

Plan Name	URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN
Plan identification number	001

URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 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

FASTMED URGENT CARE has sponsored the creation of one or more 401k plans.

Company Name: FASTMED URGENT CARE

Employer identification number (EIN): 273742499

NAIC Classification: 621498
NAIC Description: All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 CRYSTAL CAMPBELL
001 2012-01-01 CRYSTAL CAMPBELL KEVIN BLANK 2014-04-26
001 2011-01-01 KEVIN BLANK 2012-08-31

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2013-01-01	CRYSTAL CAMPBELL
001	2012-01-01	CRYSTAL CAMPBELL		KEVIN BLANK	2014-04-26
001	2011-01-01	KEVIN BLANK	2012-08-31

Plan Statistics for URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN

401k plan membership statisitcs for URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN

Measure Date Value
2013: URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 385
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 540
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 7
Total of all active and inactive participants 2013-01-01 547
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 547
Number of participants with account balances 2013-01-01 130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 11
2012: URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 170
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 380
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 5
Total of all active and inactive participants 2012-01-01 385
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 385
Number of participants with account balances 2012-01-01 97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 4

Measure	Date	Value
2013: URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	385
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	540
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	7
Total of all active and inactive participants	2013-01-01	547
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	547
Number of participants with account balances	2013-01-01	130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	11
2012: URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	170
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	380
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	5
Total of all active and inactive participants	2012-01-01	385
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	385
Number of participants with account balances	2012-01-01	97
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	4

Financial Data on URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN

Measure	Date	Value
2013 : URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN 2013 401k financial data
Unrealized appreciation/depreciation of real estate assets	2013-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$0
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total transfer of assets to this plan	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Expenses. Interest paid	2013-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$1,243,931
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$125,176
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$119,653
Expenses. Certain deemed distributions of participant loans	2013-12-31	$3,842
Value of total corrective distributions	2013-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$960,313
Value of total assets at end of year	2013-12-31	$2,419,709
Value of total assets at beginning of year	2013-12-31	$1,300,954
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$1,681
Total income from rents	2013-12-31	$0
Total interest from all sources	2013-12-31	$850
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$123,739
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$123,739
Assets. Real estate other than employer real property at end of year	2013-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2013-12-31	$0
Administrative expenses professional fees incurred	2013-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2013-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2013-12-31	$0
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$553,300
Participant contributions at end of year	2013-12-31	$57,663
Participant contributions at beginning of year	2013-12-31	$23,705
Participant contributions at end of year	2013-12-31	$0
Participant contributions at beginning of year	2013-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$133,243
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$0
Assets. Loans (other than to participants) at end of year	2013-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$0
Other income not declared elsewhere	2013-12-31	$0
Administrative expenses (other) incurred	2013-12-31	$1,681
Liabilities. Value of operating payables at end of year	2013-12-31	$0
Liabilities. Value of operating payables at beginning of year	2013-12-31	$0
Total non interest bearing cash at end of year	2013-12-31	$0
Total non interest bearing cash at beginning of year	2013-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Income. Non cash contributions	2013-12-31	$0
Value of net income/loss	2013-12-31	$1,118,755
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,419,709
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,300,954
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Assets. partnership/joint venture interests at end of year	2013-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2013-12-31	$0
Investment advisory and management fees	2013-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$2,324,652
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$1,267,008
Value of interest in pooled separate accounts at end of year	2013-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$0
Interest on participant loans	2013-12-31	$850
Income. Interest from loans (other than to participants)	2013-12-31	$0
Interest earned on other investments	2013-12-31	$0
Income. Interest from US Government securities	2013-12-31	$0
Income. Interest from corporate debt instruments	2013-12-31	$0
Value of interest in master investment trust accounts at end of year	2013-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2013-12-31	$0
Value of interest in common/collective trusts at end of year	2013-12-31	$37,394
Value of interest in common/collective trusts at beginning of year	2013-12-31	$10,241
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2013-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2013-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$0
Asset value of US Government securities at end of year	2013-12-31	$0
Asset value of US Government securities at beginning of year	2013-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$158,728
Net investment gain/loss from pooled separate accounts	2013-12-31	$0
Net investment gain or loss from common/collective trusts	2013-12-31	$301
Net gain/loss from 103.12 investment entities	2013-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Assets. Invements in employer securities at end of year	2013-12-31	$0
Assets. Invements in employer securities at beginning of year	2013-12-31	$0
Assets. Value of employer real property at end of year	2013-12-31	$0
Assets. Value of employer real property at beginning of year	2013-12-31	$0
Contributions received in cash from employer	2013-12-31	$273,770
Employer contributions (assets) at end of year	2013-12-31	$0
Employer contributions (assets) at beginning of year	2013-12-31	$0
Income. Dividends from preferred stock	2013-12-31	$0
Income. Dividends from common stock	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$119,653
Asset. Corporate debt instrument preferred debt at end of year	2013-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2013-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2013-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2013-12-31	$0
Contract administrator fees	2013-12-31	$0
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	2013-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2013-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2013-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2013-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2013-12-31	$0
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Aggregate proceeds on sale of assets	2013-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2013-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2013-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	GRANT THORNTON
Accountancy firm EIN	2013-12-31	366055558
2012 : URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$608,828
Total of all expenses incurred	2012-12-31	$129,754
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$128,598
Value of total corrective distributions	2012-12-31	$806
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$513,185
Value of total assets at end of year	2012-12-31	$1,300,954
Value of total assets at beginning of year	2012-12-31	$821,880
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$350
Total interest from all sources	2012-12-31	$148
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$24,154
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$24,154
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$313,964
Participant contributions at end of year	2012-12-31	$23,705
Participant contributions at beginning of year	2012-12-31	$3,467
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$27,348
Administrative expenses (other) incurred	2012-12-31	$350
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$479,074
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,300,954
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$821,880
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$1,267,008
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$805,352
Interest on participant loans	2012-12-31	$148
Value of interest in common/collective trusts at end of year	2012-12-31	$10,241
Value of interest in common/collective trusts at beginning of year	2012-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$71,309
Net investment gain or loss from common/collective trusts	2012-12-31	$32
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$171,873
Employer contributions (assets) at end of year	2012-12-31	$0
Employer contributions (assets) at beginning of year	2012-12-31	$13,061
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$128,598
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	2012-12-31	Yes
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	GRANT THORNTON
Accountancy firm EIN	2012-12-31	366055558

Form 5500 Responses for URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN

2013: URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) 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
2012: URGENT CARES OF AMERICA (NORTH CAROLINA), INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes

Potentially related plans

URGENT CARES OF AMERICA HOLDINGS, LLC 401(K) PLAN [EIN = 273622335]

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Company Name:	FASTMED URGENT CARE
Employer identification number (EIN):	273742499
NAIC Classification:	621498
NAIC Description:	All Other Outpatient Care Centers