401k Plan data: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST plan

LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST
Plan identification number	002

LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 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

LAKE SHORE CARDIOLOGY GROUP LTD has sponsored the creation of one or more 401k plans.

Company Name: LAKE SHORE CARDIOLOGY GROUP LTD

Employer identification number (EIN): 363398846

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2015-12-01
002 2013-12-01
002 2012-12-01 DAVID I KOENIGSBERG, MD
002 2011-12-01 DAVID I KOENIGSBERG, MD
002 2009-12-01 DAVID I KOENIGSBERG, MD
002 2008-12-01

Plan Statistics for LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST

Measure Date Value
2015: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year 2015-12-01 3
Total number of active participants reported on line 7a of the Form 5500 2015-12-01 0
Number of retired or separated participants receiving benefits 2015-12-01 0
Number of other retired or separated participants entitled to future benefits 2015-12-01 0
Total of all active and inactive participants 2015-12-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-12-01 0
Total participants 2015-12-01 0
Number of participants with account balances 2015-12-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-12-01 0
2013: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year 2013-12-01 3
Total number of active participants reported on line 7a of the Form 5500 2013-12-01 3
Total of all active and inactive participants 2013-12-01 3
Total participants 2013-12-01 3
Number of participants with account balances 2013-12-01 3
2012: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year 2012-12-01 3
Total number of active participants reported on line 7a of the Form 5500 2012-12-01 3
Total of all active and inactive participants 2012-12-01 3
Total participants 2012-12-01 3
Number of participants with account balances 2012-12-01 3
2011: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year 2011-12-01 3
Total number of active participants reported on line 7a of the Form 5500 2011-12-01 3
Total of all active and inactive participants 2011-12-01 3
Total participants 2011-12-01 3
Number of participants with account balances 2011-12-01 3
2009: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year 2009-12-01 3
Total number of active participants reported on line 7a of the Form 5500 2009-12-01 3
Total of all active and inactive participants 2009-12-01 3
Total participants 2009-12-01 3
Number of participants with account balances 2009-12-01 3

Measure	Date	Value
2015: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year	2015-12-01	3
Total number of active participants reported on line 7a of the Form 5500	2015-12-01	0
Number of retired or separated participants receiving benefits	2015-12-01	0
Number of other retired or separated participants entitled to future benefits	2015-12-01	0
Total of all active and inactive participants	2015-12-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-12-01	0
Total participants	2015-12-01	0
Number of participants with account balances	2015-12-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-12-01	0
2013: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year	2013-12-01	3
Total number of active participants reported on line 7a of the Form 5500	2013-12-01	3
Total of all active and inactive participants	2013-12-01	3
Total participants	2013-12-01	3
Number of participants with account balances	2013-12-01	3
2012: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year	2012-12-01	3
Total number of active participants reported on line 7a of the Form 5500	2012-12-01	3
Total of all active and inactive participants	2012-12-01	3
Total participants	2012-12-01	3
Number of participants with account balances	2012-12-01	3
2011: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year	2011-12-01	3
Total number of active participants reported on line 7a of the Form 5500	2011-12-01	3
Total of all active and inactive participants	2011-12-01	3
Total participants	2011-12-01	3
Number of participants with account balances	2011-12-01	3
2009: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year	2009-12-01	3
Total number of active participants reported on line 7a of the Form 5500	2009-12-01	3
Total of all active and inactive participants	2009-12-01	3
Total participants	2009-12-01	3
Number of participants with account balances	2009-12-01	3

Financial Data on LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST

Measure	Date	Value
2016 : LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2016 401k financial data
Transfers to/from the plan	2016-11-30	$-727,650
Total income from all sources	2016-11-30	$-2,976
Expenses. Total of all expenses incurred	2016-11-30	$22,466
Benefits paid (including direct rollovers)	2016-11-30	$22,466
Total plan assets at end of year	2016-11-30	$0
Total plan assets at beginning of year	2016-11-30	$753,092
Value of fidelity bond covering the plan	2016-11-30	$1,700
Other income received	2016-11-30	$-2,976
Net income (gross income less expenses)	2016-11-30	$-25,442
Net plan assets at end of year (total assets less liabilities)	2016-11-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-11-30	$753,092
2014 : LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2014 401k financial data
Total income from all sources	2014-11-30	$60,849
Expenses. Total of all expenses incurred	2014-11-30	$93,667
Benefits paid (including direct rollovers)	2014-11-30	$93,667
Total plan assets at end of year	2014-11-30	$843,347
Total plan assets at beginning of year	2014-11-30	$876,165
Value of fidelity bond covering the plan	2014-11-30	$1,700
Other income received	2014-11-30	$60,849
Net income (gross income less expenses)	2014-11-30	$-32,818
Net plan assets at end of year (total assets less liabilities)	2014-11-30	$843,347
Net plan assets at beginning of year (total assets less liabilities)	2014-11-30	$876,165
2013 : LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2013 401k financial data
Total income from all sources	2013-11-30	$15,307
Expenses. Total of all expenses incurred	2013-11-30	$75,000
Benefits paid (including direct rollovers)	2013-11-30	$75,000
Total plan assets at end of year	2013-11-30	$876,165
Total plan assets at beginning of year	2013-11-30	$935,858
Value of fidelity bond covering the plan	2013-11-30	$17,000
Other income received	2013-11-30	$15,307
Net income (gross income less expenses)	2013-11-30	$-59,693
Net plan assets at end of year (total assets less liabilities)	2013-11-30	$876,165
Net plan assets at beginning of year (total assets less liabilities)	2013-11-30	$935,858
2012 : LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2012 401k financial data
Total income from all sources	2012-11-30	$80,374
Total plan assets at end of year	2012-11-30	$935,858
Total plan assets at beginning of year	2012-11-30	$855,484
Value of fidelity bond covering the plan	2012-11-30	$17,000
Other income received	2012-11-30	$80,374
Net income (gross income less expenses)	2012-11-30	$80,374
Net plan assets at end of year (total assets less liabilities)	2012-11-30	$935,858
Net plan assets at beginning of year (total assets less liabilities)	2012-11-30	$855,484
2011 : LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2011 401k financial data
Total income from all sources	2011-11-30	$11,573
Total plan assets at end of year	2011-11-30	$855,484
Total plan assets at beginning of year	2011-11-30	$843,911
Value of fidelity bond covering the plan	2011-11-30	$17,000
Other income received	2011-11-30	$11,573
Net income (gross income less expenses)	2011-11-30	$11,573
Net plan assets at end of year (total assets less liabilities)	2011-11-30	$855,484
Net plan assets at beginning of year (total assets less liabilities)	2011-11-30	$843,911

Form 5500 Responses for LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST

2015: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2015 form 5500 responses
2015-12-01	Type of plan entity	Single employer plan
2015-12-01	This submission is the final filing	Yes
2015-12-01	Plan funding arrangement – Trust	Yes
2015-12-01	Plan benefit arrangement - Trust	Yes
2013: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2013 form 5500 responses
2013-12-01	Type of plan entity	Single employer plan
2013-12-01	Plan funding arrangement – Trust	Yes
2013-12-01	Plan benefit arrangement - Trust	Yes
2012: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2012 form 5500 responses
2012-12-01	Type of plan entity	Single employer plan
2012-12-01	Plan funding arrangement – Trust	Yes
2012-12-01	Plan benefit arrangement - Trust	Yes
2011: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2011 form 5500 responses
2011-12-01	Type of plan entity	Single employer plan
2011-12-01	Plan funding arrangement – Trust	Yes
2011-12-01	Plan benefit arrangement - Trust	Yes
2009: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2009 form 5500 responses
2009-12-01	Type of plan entity	Single employer plan
2009-12-01	This submission is the final filing	No
2009-12-01	Plan funding arrangement – Trust	Yes
2009-12-01	Plan benefit arrangement - Trust	Yes
2008: LAKE SHORE CARDIOLOGY GROUP LTD PROFIT SHARING PLAN & TRUST 2008 form 5500 responses
2008-12-01	Type of plan entity	Single employer plan
2008-12-01	Submission has been amended	No
2008-12-01	This submission is the final filing	No
2008-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-12-01	Plan is a collectively bargained plan	No

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Company Name:	LAKE SHORE CARDIOLOGY GROUP LTD
Employer identification number (EIN):	363398846
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)