401k Plan data: JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN plan

JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN
Plan identification number	003

JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Profit-sharing 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

JOHN W. PUCKETT, M.D., FACS, INC. has sponsored the creation of one or more 401k plans.

Company Name: JOHN W. PUCKETT, M.D., FACS, INC.

Employer identification number (EIN): 330536393

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2017-01-01
003 2016-01-01
003 2015-01-01
003 2014-01-01 TERESA URANGA 2015-10-16
003 2013-01-01 TERESA URANGA 2014-09-29
003 2012-01-01 TERESA URANGA
003 2011-01-01 TERESA URANGA
003 2009-01-01 JOHN PUCKETT

Plan Statistics for JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN

Measure Date Value
2012: JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1
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 3
Total of all active and inactive participants 2012-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 4
Number of participants with account balances 2012-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1
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 4
Total of all active and inactive participants 2011-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 5
Number of participants with account balances 2011-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 3
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 2
Total of all active and inactive participants 2009-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 5
Number of participants with account balances 2009-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2012: JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1
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	3
Total of all active and inactive participants	2012-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	4
Number of participants with account balances	2012-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1
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	4
Total of all active and inactive participants	2011-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	5
Number of participants with account balances	2011-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	3
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	2
Total of all active and inactive participants	2009-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	5
Number of participants with account balances	2009-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN

Measure	Date	Value
2012 : JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$174,986
Expenses. Total of all expenses incurred	2012-12-31	$33,253
Benefits paid (including direct rollovers)	2012-12-31	$20,705
Total plan assets at end of year	2012-12-31	$1,329,881
Total plan assets at beginning of year	2012-12-31	$1,188,148
Value of fidelity bond covering the plan	2012-12-31	$100,000
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$146,186
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$141,733
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,329,881
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,188,148
Assets. Value of assets in partnership/joint-venture interests	2012-12-31	$10,000
Total contributions received or receivable from employer(s)	2012-12-31	$28,800
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$12,548
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$37,528
Expenses. Total of all expenses incurred	2011-12-31	$10,998
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$1,188,148
Total plan assets at beginning of year	2011-12-31	$1,161,618
Value of fidelity bond covering the plan	2011-12-31	$100,000
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-15,425
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$26,530
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,188,148
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,161,618
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$10,000
Total contributions received or receivable from employer(s)	2011-12-31	$52,953
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$10,998
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$162,611
Expenses. Total of all expenses incurred	2010-12-31	$9,171
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$1,161,618
Total plan assets at beginning of year	2010-12-31	$1,008,178
Value of fidelity bond covering the plan	2010-12-31	$100,000
Total contributions received or receivable from participants	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$9,171
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$104,131
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$153,440
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,161,618
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,008,178
Total contributions received or receivable from employer(s)	2010-12-31	$58,480
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0

Form 5500 Responses for JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN

2012: JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING 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 is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: JOHN W. PUCKETT, M.D., FACS, INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	JOHN W. PUCKETT, M.D., FACS, INC.
Employer identification number (EIN):	330536393
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
003	2017-01-01
003	2016-01-01
003	2015-01-01
003	2014-01-01	TERESA URANGA	2015-10-16
003	2013-01-01	TERESA URANGA	2014-09-29
003	2012-01-01	TERESA URANGA
003	2011-01-01	TERESA URANGA
003	2009-01-01	JOHN PUCKETT