401k Plan data: CAPITOL IMAGING, LLC RETIREMENT PLAN plan

CAPITOL IMAGING, LLC RETIREMENT PLAN 401k Plan overview

Plan Name	CAPITOL IMAGING, LLC RETIREMENT PLAN
Plan identification number	001

CAPITOL IMAGING, LLC RETIREMENT 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

CAPITOL IMAGING, LLC has sponsored the creation of one or more 401k plans.

Company Name: CAPITOL IMAGING, LLC

Employer identification number (EIN): 474549323

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAPITOL IMAGING, LLC RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01 JOHN STAGG 2020-10-06
001 2019-01-01 JOHN STAGG 2021-03-22
001 2018-01-01 JOHN HAMIDE 2019-10-14
001 2017-01-01
001 2016-09-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2019-01-01	JOHN STAGG	2020-10-06
001	2019-01-01	JOHN STAGG	2021-03-22
001	2018-01-01	JOHN HAMIDE	2019-10-14
001	2017-01-01
001	2016-09-01

Plan Statistics for CAPITOL IMAGING, LLC RETIREMENT PLAN

401k plan membership statisitcs for CAPITOL IMAGING, LLC RETIREMENT PLAN

Measure Date Value
2019: CAPITOL IMAGING, LLC RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 211
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 187
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 26
Total of all active and inactive participants 2019-01-01 213
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 213
Number of participants with account balances 2019-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: CAPITOL IMAGING, LLC RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 196
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 199
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 12
Total of all active and inactive participants 2018-01-01 211
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 211
Number of participants with account balances 2018-01-01 106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0

Measure	Date	Value
2019: CAPITOL IMAGING, LLC RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	211
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	187
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	26
Total of all active and inactive participants	2019-01-01	213
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	213
Number of participants with account balances	2019-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: CAPITOL IMAGING, LLC RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	196
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	199
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	12
Total of all active and inactive participants	2018-01-01	211
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	211
Number of participants with account balances	2018-01-01	106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0

Financial Data on CAPITOL IMAGING, LLC RETIREMENT PLAN

Measure	Date	Value
2019 : CAPITOL IMAGING, LLC RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$1,917
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$1,917
Total income from all sources (including contributions)	2019-12-31	$937,026
Total income from all sources (including contributions)	2019-12-31	$937,026
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$32,567
Total of all expenses incurred	2019-12-31	$32,567
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$29,279
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$29,279
Expenses. Certain deemed distributions of participant loans	2019-12-31	$1,742
Expenses. Certain deemed distributions of participant loans	2019-12-31	$1,742
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$461,742
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$461,742
Value of total assets at end of year	2019-12-31	$2,857,988
Value of total assets at end of year	2019-12-31	$2,857,988
Value of total assets at beginning of year	2019-12-31	$1,955,446
Value of total assets at beginning of year	2019-12-31	$1,955,446
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,546
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,546
Total interest from all sources	2019-12-31	$4,151
Total interest from all sources	2019-12-31	$4,151
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Administrative expenses professional fees incurred	2019-12-31	$1,546
Administrative expenses professional fees incurred	2019-12-31	$1,546
Was this plan covered by a fidelity bond	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$291,361
Contributions received from participants	2019-12-31	$291,361
Participant contributions at end of year	2019-12-31	$45,614
Participant contributions at end of year	2019-12-31	$45,614
Participant contributions at beginning of year	2019-12-31	$36,484
Participant contributions at beginning of year	2019-12-31	$36,484
Participant contributions at end of year	2019-12-31	$269
Participant contributions at end of year	2019-12-31	$269
Participant contributions at beginning of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$170,381
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$170,381
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$1,917
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$1,917
Other income not declared elsewhere	2019-12-31	$1,918
Other income not declared elsewhere	2019-12-31	$1,918
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$904,459
Value of net income/loss	2019-12-31	$904,459
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,857,988
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,857,988
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,953,529
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,953,529
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in pooled separate accounts at end of year	2019-12-31	$2,785,387
Value of interest in pooled separate accounts at end of year	2019-12-31	$2,785,387
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$1,910,142
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$1,910,142
Interest on participant loans	2019-12-31	$4,151
Interest on participant loans	2019-12-31	$4,151
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$26,718
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$26,718
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$8,820
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$8,820
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$469,215
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$469,215
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$29,279
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$29,279
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	APPLE GUERIN COMPANY, LLC
Accountancy firm name	2019-12-31	APPLE GUERIN COMPANY, LLC
Accountancy firm EIN	2019-12-31	721348954
Accountancy firm EIN	2019-12-31	721348954
2018 : CAPITOL IMAGING, LLC RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total transfer of assets to this plan	2018-12-31	$44,144
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$1,917
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$636
Total income from all sources (including contributions)	2018-12-31	$169,137
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$83,018
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$78,907
Value of total corrective distributions	2018-12-31	$2,373
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$322,718
Value of total assets at end of year	2018-12-31	$1,955,446
Value of total assets at beginning of year	2018-12-31	$1,823,902
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$1,738
Total interest from all sources	2018-12-31	$2,383
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$1,738
Was this plan covered by a fidelity bond	2018-12-31	No
If this is an individual account plan, was there a blackout period	2018-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$295,794
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$122
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$26,924
Assets. Loans (other than to participants) at end of year	2018-12-31	$36,484
Assets. Loans (other than to participants) at beginning of year	2018-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$1,917
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$636
Other income not declared elsewhere	2018-12-31	$526
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$86,119
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,953,529
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,823,266
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in pooled separate accounts at end of year	2018-12-31	$1,910,142
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$1,822,161
Interest on participant loans	2018-12-31	$2,383
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$8,820
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$1,509
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-156,490
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$0
Employer contributions (assets) at end of year	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$110
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$78,907
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	2018-12-31	Yes
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	APPLE GUERIN COMPANY, LLC
Accountancy firm EIN	2018-12-31	721348954

Form 5500 Responses for CAPITOL IMAGING, LLC RETIREMENT PLAN

2019: CAPITOL IMAGING, LLC RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: CAPITOL IMAGING, LLC RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	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

842457

Policy instance

Insurance contract or identification number	842457
Number of Individuals Covered	117
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $7,066
Total amount of fees paid to insurance company	USD $1,129
Are there contracts with allocated funds for individual policies?	0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,066
Insurance broker organization code?	3
Amount paid for insurance broker fees	1129
Additional information about fees paid to insurance broker	ADMIN FEES & ALLOWANCE

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

Policy contract number

842457

Policy instance

Insurance contract or identification number	842457
Number of Individuals Covered	106
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,653
Total amount of fees paid to insurance company	USD $4,711
Are there contracts with allocated funds for individual policies?	0
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?	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,664
Insurance broker organization code?	3
Amount paid for insurance broker fees	4711
Additional information about fees paid to insurance broker	ADMIN FEES & ALLOWANCE

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Company Name:	CAPITOL IMAGING, LLC
Employer identification number (EIN):	474549323
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)