401k Plan data: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN plan

GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 401k Plan overview

Plan Name	GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN
Plan identification number	002

GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Cash balance or similar plan - Plan has a "cash balance" formula. For this purpose, a "cash balance" formula is a benefit formula in a defined benefit plan by whatever name (for example, personal account plan, pension equity plan, life cycle plan, cash account plan, etc.) that rather than, or in addition to, expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee in terms more common to a defined contribution plan such as a single sum distribution amount (for example, 10 percent of final average pay times years of service, or the amount of the employee's hypothetical account balance).
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

GOOD SAMARITAN MEDICAL CLINIC, INC. has sponsored the creation of one or more 401k plans.

Company Name: GOOD SAMARITAN MEDICAL CLINIC, INC.

Employer identification number (EIN): 481287468

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2023-01-01
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01
002 2016-01-01
002 2015-01-01

Plan Statistics for GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN

401k plan membership statisitcs for GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN

Measure Date Value
2022: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2022 401k membership
Market value of plan assets 2022-12-31 1,763,202
Acturial value of plan assets 2022-12-31 1,763,202
Funding target for retired participants and beneficiaries receiving payment 2022-12-31 0
Number of terminated vested participants 2022-12-31 3
Fundng target for terminated vested participants 2022-12-31 401
Active participant vested funding target 2022-12-31 1,563,381
Number of active participants 2022-12-31 21
Total funding liabilities for active participants 2022-12-31 1,563,381
Total participant count 2022-12-31 24
Total funding target for all participants 2022-12-31 1,563,782
Balance at beginning of prior year after applicable adjustments 2022-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2022-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2022-12-31 0
Prefunding balanced used to offset prior years funding requirement 2022-12-31 0
Amount remaining of carryover balance 2022-12-31 0
Amount remaining of prefunding balance 2022-12-31 0
Present value of excess contributions 2022-12-31 245,049
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2022-12-31 245,049
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2022-12-31 0
Reductions in caryover balances due to elections or deemed elections 2022-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2022-12-31 0
Balance of carryovers at beginning of current year 2022-12-31 0
Balance of prefunding at beginning of current year 2022-12-31 0
Total employer contributions 2022-12-31 150,000
Total employee contributions 2022-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2022-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2022-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2022-12-31 146,405
Unpaid minimum required contributions for all prior years 2022-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2022-12-31 0
Remaining amount of unpaid minimum required contributions 2022-12-31 0
Minimum required contributions for current year target normal cost 2022-12-31 208,601
Net shortfall amortization installment of oustanding balance 2022-12-31 0
Waiver amortization installment 2022-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2022-12-31 9,181
Carryover balance elected to use to offset funding requirement 2022-12-31 0
Prefunding balance elected to use to offset funding requirement 2022-12-31 0
Additional cash requirement 2022-12-31 9,181
Contributions allocatedtoward minimum required contributions for current year 2022-12-31 146,405
Unpaid minimum required contributions for current year 2022-12-31 0
Unpaid minimum required contributions for all years 2022-12-31 0
2021: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2021 401k membership
Market value of plan assets 2021-12-31 1,779,105
Acturial value of plan assets 2021-12-31 1,779,105
Funding target for retired participants and beneficiaries receiving payment 2021-12-31 0
Number of terminated vested participants 2021-12-31 4
Fundng target for terminated vested participants 2021-12-31 1,268
Active participant vested funding target 2021-12-31 1,216,920
Number of active participants 2021-12-31 21
Total funding liabilities for active participants 2021-12-31 1,217,524
Total participant count 2021-12-31 25
Total funding target for all participants 2021-12-31 1,218,792
Balance at beginning of prior year after applicable adjustments 2021-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2021-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2021-12-31 0
Prefunding balanced used to offset prior years funding requirement 2021-12-31 0
Amount remaining of carryover balance 2021-12-31 0
Amount remaining of prefunding balance 2021-12-31 0
Present value of excess contributions 2021-12-31 296,198
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2021-12-31 296,198
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2021-12-31 0
Reductions in caryover balances due to elections or deemed elections 2021-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2021-12-31 0
Balance of carryovers at beginning of current year 2021-12-31 0
Balance of prefunding at beginning of current year 2021-12-31 0
Total employer contributions 2021-12-31 250,000
Total employee contributions 2021-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2021-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2021-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2021-12-31 245,049
Unpaid minimum required contributions for all prior years 2021-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2021-12-31 0
Remaining amount of unpaid minimum required contributions 2021-12-31 0
Minimum required contributions for current year target normal cost 2021-12-31 239,810
Net shortfall amortization installment of oustanding balance 2021-12-31 0
Waiver amortization installment 2021-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2021-12-31 0
Carryover balance elected to use to offset funding requirement 2021-12-31 0
Prefunding balance elected to use to offset funding requirement 2021-12-31 0
Additional cash requirement 2021-12-31 0
Contributions allocatedtoward minimum required contributions for current year 2021-12-31 245,049
Unpaid minimum required contributions for current year 2021-12-31 0
Unpaid minimum required contributions for all years 2021-12-31 0
2020: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2020 401k membership
Market value of plan assets 2020-12-31 1,317,332
Acturial value of plan assets 2020-12-31 1,317,332
Funding target for retired participants and beneficiaries receiving payment 2020-12-31 0
Number of terminated vested participants 2020-12-31 5
Fundng target for terminated vested participants 2020-12-31 1,064
Active participant vested funding target 2020-12-31 934,330
Number of active participants 2020-12-31 20
Total funding liabilities for active participants 2020-12-31 934,637
Total participant count 2020-12-31 25
Total funding target for all participants 2020-12-31 935,701
Balance at beginning of prior year after applicable adjustments 2020-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2020-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2020-12-31 0
Prefunding balanced used to offset prior years funding requirement 2020-12-31 0
Amount remaining of carryover balance 2020-12-31 0
Amount remaining of prefunding balance 2020-12-31 0
Present value of excess contributions 2020-12-31 289,029
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2020-12-31 289,029
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2020-12-31 0
Reductions in caryover balances due to elections or deemed elections 2020-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2020-12-31 0
Balance of carryovers at beginning of current year 2020-12-31 0
Balance of prefunding at beginning of current year 2020-12-31 0
Total employer contributions 2020-12-31 300,000
Total employee contributions 2020-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2020-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2020-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2020-12-31 296,198
Unpaid minimum required contributions for all prior years 2020-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2020-12-31 0
Remaining amount of unpaid minimum required contributions 2020-12-31 0
Minimum required contributions for current year target normal cost 2020-12-31 198,838
Net shortfall amortization installment of oustanding balance 2020-12-31 0
Waiver amortization installment 2020-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2020-12-31 0
Carryover balance elected to use to offset funding requirement 2020-12-31 0
Prefunding balance elected to use to offset funding requirement 2020-12-31 0
Additional cash requirement 2020-12-31 0
Contributions allocatedtoward minimum required contributions for current year 2020-12-31 296,198
Unpaid minimum required contributions for current year 2020-12-31 0
Unpaid minimum required contributions for all years 2020-12-31 0
2019: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2019 401k membership
Market value of plan assets 2019-12-31 927,525
Acturial value of plan assets 2019-12-31 927,525
Funding target for retired participants and beneficiaries receiving payment 2019-12-31 0
Number of terminated vested participants 2019-12-31 1
Fundng target for terminated vested participants 2019-12-31 630
Active participant vested funding target 2019-12-31 619,455
Number of active participants 2019-12-31 21
Total funding liabilities for active participants 2019-12-31 619,455
Total participant count 2019-12-31 22
Total funding target for all participants 2019-12-31 620,085
Balance at beginning of prior year after applicable adjustments 2019-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2019-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2019-12-31 0
Prefunding balanced used to offset prior years funding requirement 2019-12-31 0
Amount remaining of carryover balance 2019-12-31 0
Amount remaining of prefunding balance 2019-12-31 0
Present value of excess contributions 2019-12-31 245,999
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2019-12-31 245,999
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2019-12-31 0
Reductions in caryover balances due to elections or deemed elections 2019-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2019-12-31 0
Balance of carryovers at beginning of current year 2019-12-31 0
Balance of prefunding at beginning of current year 2019-12-31 0
Total employer contributions 2019-12-31 300,000
Total employee contributions 2019-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2019-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2019-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2019-12-31 289,029
Unpaid minimum required contributions for all prior years 2019-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2019-12-31 0
Remaining amount of unpaid minimum required contributions 2019-12-31 0
Minimum required contributions for current year target normal cost 2019-12-31 190,246
Net shortfall amortization installment of oustanding balance 2019-12-31 0
Waiver amortization installment 2019-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2019-12-31 0
Additional cash requirement 2019-12-31 0
Contributions allocatedtoward minimum required contributions for current year 2019-12-31 289,029
Unpaid minimum required contributions for current year 2019-12-31 0
Unpaid minimum required contributions for all years 2019-12-31 0
2018: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2018 401k membership
Market value of plan assets 2018-12-31 481,301
Acturial value of plan assets 2018-12-31 481,301
Funding target for retired participants and beneficiaries receiving payment 2018-12-31 0
Number of terminated vested participants 2018-12-31 3
Fundng target for terminated vested participants 2018-12-31 876
Active participant vested funding target 2018-12-31 419,226
Number of active participants 2018-12-31 18
Total funding liabilities for active participants 2018-12-31 419,226
Total participant count 2018-12-31 21
Total funding target for all participants 2018-12-31 420,102
Balance at beginning of prior year after applicable adjustments 2018-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2018-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2018-12-31 0
Prefunding balanced used to offset prior years funding requirement 2018-12-31 0
Amount remaining of carryover balance 2018-12-31 0
Amount remaining of prefunding balance 2018-12-31 0
Present value of excess contributions 2018-12-31 126,082
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2018-12-31 126,082
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2018-12-31 0
Reductions in caryover balances due to elections or deemed elections 2018-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2018-12-31 0
Balance of carryovers at beginning of current year 2018-12-31 0
Balance of prefunding at beginning of current year 2018-12-31 0
Total employer contributions 2018-12-31 356,000
Total employee contributions 2018-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2018-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2018-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2018-12-31 338,084
Unpaid minimum required contributions for all prior years 2018-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2018-12-31 0
Remaining amount of unpaid minimum required contributions 2018-12-31 0
Minimum required contributions for current year target normal cost 2018-12-31 153,284
Net shortfall amortization installment of oustanding balance 2018-12-31 0
Waiver amortization installment 2018-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2018-12-31 92,085
Additional cash requirement 2018-12-31 92,085
Contributions allocatedtoward minimum required contributions for current year 2018-12-31 338,084
Unpaid minimum required contributions for current year 2018-12-31 0
Unpaid minimum required contributions for all years 2018-12-31 0
2017: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2017 401k membership
Market value of plan assets 2017-12-31 379,893
Acturial value of plan assets 2017-12-31 379,893
Funding target for retired participants and beneficiaries receiving payment 2017-12-31 0
Number of terminated vested participants 2017-12-31 1
Fundng target for terminated vested participants 2017-12-31 286
Active participant vested funding target 2017-12-31 309,151
Number of active participants 2017-12-31 20
Total funding liabilities for active participants 2017-12-31 309,398
Total participant count 2017-12-31 21
Total funding target for all participants 2017-12-31 309,684
Balance at beginning of prior year after applicable adjustments 2017-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2017-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2017-12-31 0
Prefunding balanced used to offset prior years funding requirement 2017-12-31 0
Amount remaining of carryover balance 2017-12-31 0
Amount remaining of prefunding balance 2017-12-31 0
Present value of excess contributions 2017-12-31 72,555
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2017-12-31 72,555
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2017-12-31 0
Reductions in caryover balances due to elections or deemed elections 2017-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2017-12-31 0
Balance of carryovers at beginning of current year 2017-12-31 0
Balance of prefunding at beginning of current year 2017-12-31 0
Total employer contributions 2017-12-31 130,491
Total employee contributions 2017-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2017-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2017-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2017-12-31 126,082
Unpaid minimum required contributions for all prior years 2017-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2017-12-31 0
Remaining amount of unpaid minimum required contributions 2017-12-31 0
Minimum required contributions for current year target normal cost 2017-12-31 61,671
Net shortfall amortization installment of oustanding balance 2017-12-31 0
Waiver amortization installment 2017-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2017-12-31 0
Additional cash requirement 2017-12-31 0
Contributions allocatedtoward minimum required contributions for current year 2017-12-31 126,082
Unpaid minimum required contributions for current year 2017-12-31 0
Unpaid minimum required contributions for all years 2017-12-31 0
2016: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2016 401k membership
Market value of plan assets 2016-12-31 196,922
Acturial value of plan assets 2016-12-31 196,922
Funding target for retired participants and beneficiaries receiving payment 2016-12-31 0
Number of terminated vested participants 2016-12-31 1
Fundng target for terminated vested participants 2016-12-31 256
Active participant vested funding target 2016-12-31 151,172
Number of active participants 2016-12-31 15
Total funding liabilities for active participants 2016-12-31 151,391
Total participant count 2016-12-31 16
Total funding target for all participants 2016-12-31 151,647
Balance at beginning of prior year after applicable adjustments 2016-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2016-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2016-12-31 0
Prefunding balanced used to offset prior years funding requirement 2016-12-31 0
Amount remaining of carryover balance 2016-12-31 0
Amount remaining of prefunding balance 2016-12-31 0
Present value of excess contributions 2016-12-31 54,695
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2016-12-31 54,695
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2016-12-31 0
Reductions in caryover balances due to elections or deemed elections 2016-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2016-12-31 0
Balance of carryovers at beginning of current year 2016-12-31 0
Balance of prefunding at beginning of current year 2016-12-31 0
Total employer contributions 2016-12-31 163,387
Total employee contributions 2016-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2016-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2016-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2016-12-31 158,288
Unpaid minimum required contributions for all prior years 2016-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2016-12-31 0
Remaining amount of unpaid minimum required contributions 2016-12-31 0
Minimum required contributions for current year target normal cost 2016-12-31 131,008
Net shortfall amortization installment of oustanding balance 2016-12-31 0
Waiver amortization installment 2016-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2016-12-31 85,733
Additional cash requirement 2016-12-31 85,733
Contributions allocatedtoward minimum required contributions for current year 2016-12-31 158,288
Unpaid minimum required contributions for current year 2016-12-31 0
Unpaid minimum required contributions for all years 2016-12-31 0

Measure	Date	Value
2022: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2022 401k membership
Market value of plan assets	2022-12-31	1,763,202
Acturial value of plan assets	2022-12-31	1,763,202
Funding target for retired participants and beneficiaries receiving payment	2022-12-31	0
Number of terminated vested participants	2022-12-31	3
Fundng target for terminated vested participants	2022-12-31	401
Active participant vested funding target	2022-12-31	1,563,381
Number of active participants	2022-12-31	21
Total funding liabilities for active participants	2022-12-31	1,563,381
Total participant count	2022-12-31	24
Total funding target for all participants	2022-12-31	1,563,782
Balance at beginning of prior year after applicable adjustments	2022-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2022-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2022-12-31	0
Prefunding balanced used to offset prior years funding requirement	2022-12-31	0
Amount remaining of carryover balance	2022-12-31	0
Amount remaining of prefunding balance	2022-12-31	0
Present value of excess contributions	2022-12-31	245,049
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2022-12-31	245,049
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2022-12-31	0
Reductions in caryover balances due to elections or deemed elections	2022-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2022-12-31	0
Balance of carryovers at beginning of current year	2022-12-31	0
Balance of prefunding at beginning of current year	2022-12-31	0
Total employer contributions	2022-12-31	150,000
Total employee contributions	2022-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2022-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2022-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2022-12-31	146,405
Unpaid minimum required contributions for all prior years	2022-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2022-12-31	0
Remaining amount of unpaid minimum required contributions	2022-12-31	0
Minimum required contributions for current year target normal cost	2022-12-31	208,601
Net shortfall amortization installment of oustanding balance	2022-12-31	0
Waiver amortization installment	2022-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2022-12-31	9,181
Carryover balance elected to use to offset funding requirement	2022-12-31	0
Prefunding balance elected to use to offset funding requirement	2022-12-31	0
Additional cash requirement	2022-12-31	9,181
Contributions allocatedtoward minimum required contributions for current year	2022-12-31	146,405
Unpaid minimum required contributions for current year	2022-12-31	0
Unpaid minimum required contributions for all years	2022-12-31	0
2021: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2021 401k membership
Market value of plan assets	2021-12-31	1,779,105
Acturial value of plan assets	2021-12-31	1,779,105
Funding target for retired participants and beneficiaries receiving payment	2021-12-31	0
Number of terminated vested participants	2021-12-31	4
Fundng target for terminated vested participants	2021-12-31	1,268
Active participant vested funding target	2021-12-31	1,216,920
Number of active participants	2021-12-31	21
Total funding liabilities for active participants	2021-12-31	1,217,524
Total participant count	2021-12-31	25
Total funding target for all participants	2021-12-31	1,218,792
Balance at beginning of prior year after applicable adjustments	2021-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2021-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2021-12-31	0
Prefunding balanced used to offset prior years funding requirement	2021-12-31	0
Amount remaining of carryover balance	2021-12-31	0
Amount remaining of prefunding balance	2021-12-31	0
Present value of excess contributions	2021-12-31	296,198
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2021-12-31	296,198
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2021-12-31	0
Reductions in caryover balances due to elections or deemed elections	2021-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2021-12-31	0
Balance of carryovers at beginning of current year	2021-12-31	0
Balance of prefunding at beginning of current year	2021-12-31	0
Total employer contributions	2021-12-31	250,000
Total employee contributions	2021-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2021-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2021-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2021-12-31	245,049
Unpaid minimum required contributions for all prior years	2021-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2021-12-31	0
Remaining amount of unpaid minimum required contributions	2021-12-31	0
Minimum required contributions for current year target normal cost	2021-12-31	239,810
Net shortfall amortization installment of oustanding balance	2021-12-31	0
Waiver amortization installment	2021-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2021-12-31	0
Carryover balance elected to use to offset funding requirement	2021-12-31	0
Prefunding balance elected to use to offset funding requirement	2021-12-31	0
Additional cash requirement	2021-12-31	0
Contributions allocatedtoward minimum required contributions for current year	2021-12-31	245,049
Unpaid minimum required contributions for current year	2021-12-31	0
Unpaid minimum required contributions for all years	2021-12-31	0
2020: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2020 401k membership
Market value of plan assets	2020-12-31	1,317,332
Acturial value of plan assets	2020-12-31	1,317,332
Funding target for retired participants and beneficiaries receiving payment	2020-12-31	0
Number of terminated vested participants	2020-12-31	5
Fundng target for terminated vested participants	2020-12-31	1,064
Active participant vested funding target	2020-12-31	934,330
Number of active participants	2020-12-31	20
Total funding liabilities for active participants	2020-12-31	934,637
Total participant count	2020-12-31	25
Total funding target for all participants	2020-12-31	935,701
Balance at beginning of prior year after applicable adjustments	2020-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2020-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2020-12-31	0
Prefunding balanced used to offset prior years funding requirement	2020-12-31	0
Amount remaining of carryover balance	2020-12-31	0
Amount remaining of prefunding balance	2020-12-31	0
Present value of excess contributions	2020-12-31	289,029
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2020-12-31	289,029
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2020-12-31	0
Reductions in caryover balances due to elections or deemed elections	2020-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2020-12-31	0
Balance of carryovers at beginning of current year	2020-12-31	0
Balance of prefunding at beginning of current year	2020-12-31	0
Total employer contributions	2020-12-31	300,000
Total employee contributions	2020-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2020-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2020-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2020-12-31	296,198
Unpaid minimum required contributions for all prior years	2020-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2020-12-31	0
Remaining amount of unpaid minimum required contributions	2020-12-31	0
Minimum required contributions for current year target normal cost	2020-12-31	198,838
Net shortfall amortization installment of oustanding balance	2020-12-31	0
Waiver amortization installment	2020-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2020-12-31	0
Carryover balance elected to use to offset funding requirement	2020-12-31	0
Prefunding balance elected to use to offset funding requirement	2020-12-31	0
Additional cash requirement	2020-12-31	0
Contributions allocatedtoward minimum required contributions for current year	2020-12-31	296,198
Unpaid minimum required contributions for current year	2020-12-31	0
Unpaid minimum required contributions for all years	2020-12-31	0
2019: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2019 401k membership
Market value of plan assets	2019-12-31	927,525
Acturial value of plan assets	2019-12-31	927,525
Funding target for retired participants and beneficiaries receiving payment	2019-12-31	0
Number of terminated vested participants	2019-12-31	1
Fundng target for terminated vested participants	2019-12-31	630
Active participant vested funding target	2019-12-31	619,455
Number of active participants	2019-12-31	21
Total funding liabilities for active participants	2019-12-31	619,455
Total participant count	2019-12-31	22
Total funding target for all participants	2019-12-31	620,085
Balance at beginning of prior year after applicable adjustments	2019-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2019-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2019-12-31	0
Prefunding balanced used to offset prior years funding requirement	2019-12-31	0
Amount remaining of carryover balance	2019-12-31	0
Amount remaining of prefunding balance	2019-12-31	0
Present value of excess contributions	2019-12-31	245,999
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2019-12-31	245,999
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2019-12-31	0
Reductions in caryover balances due to elections or deemed elections	2019-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2019-12-31	0
Balance of carryovers at beginning of current year	2019-12-31	0
Balance of prefunding at beginning of current year	2019-12-31	0
Total employer contributions	2019-12-31	300,000
Total employee contributions	2019-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2019-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2019-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2019-12-31	289,029
Unpaid minimum required contributions for all prior years	2019-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2019-12-31	0
Remaining amount of unpaid minimum required contributions	2019-12-31	0
Minimum required contributions for current year target normal cost	2019-12-31	190,246
Net shortfall amortization installment of oustanding balance	2019-12-31	0
Waiver amortization installment	2019-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2019-12-31	0
Additional cash requirement	2019-12-31	0
Contributions allocatedtoward minimum required contributions for current year	2019-12-31	289,029
Unpaid minimum required contributions for current year	2019-12-31	0
Unpaid minimum required contributions for all years	2019-12-31	0
2018: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2018 401k membership
Market value of plan assets	2018-12-31	481,301
Acturial value of plan assets	2018-12-31	481,301
Funding target for retired participants and beneficiaries receiving payment	2018-12-31	0
Number of terminated vested participants	2018-12-31	3
Fundng target for terminated vested participants	2018-12-31	876
Active participant vested funding target	2018-12-31	419,226
Number of active participants	2018-12-31	18
Total funding liabilities for active participants	2018-12-31	419,226
Total participant count	2018-12-31	21
Total funding target for all participants	2018-12-31	420,102
Balance at beginning of prior year after applicable adjustments	2018-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2018-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2018-12-31	0
Prefunding balanced used to offset prior years funding requirement	2018-12-31	0
Amount remaining of carryover balance	2018-12-31	0
Amount remaining of prefunding balance	2018-12-31	0
Present value of excess contributions	2018-12-31	126,082
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2018-12-31	126,082
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2018-12-31	0
Reductions in caryover balances due to elections or deemed elections	2018-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2018-12-31	0
Balance of carryovers at beginning of current year	2018-12-31	0
Balance of prefunding at beginning of current year	2018-12-31	0
Total employer contributions	2018-12-31	356,000
Total employee contributions	2018-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2018-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2018-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2018-12-31	338,084
Unpaid minimum required contributions for all prior years	2018-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2018-12-31	0
Remaining amount of unpaid minimum required contributions	2018-12-31	0
Minimum required contributions for current year target normal cost	2018-12-31	153,284
Net shortfall amortization installment of oustanding balance	2018-12-31	0
Waiver amortization installment	2018-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2018-12-31	92,085
Additional cash requirement	2018-12-31	92,085
Contributions allocatedtoward minimum required contributions for current year	2018-12-31	338,084
Unpaid minimum required contributions for current year	2018-12-31	0
Unpaid minimum required contributions for all years	2018-12-31	0
2017: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2017 401k membership
Market value of plan assets	2017-12-31	379,893
Acturial value of plan assets	2017-12-31	379,893
Funding target for retired participants and beneficiaries receiving payment	2017-12-31	0
Number of terminated vested participants	2017-12-31	1
Fundng target for terminated vested participants	2017-12-31	286
Active participant vested funding target	2017-12-31	309,151
Number of active participants	2017-12-31	20
Total funding liabilities for active participants	2017-12-31	309,398
Total participant count	2017-12-31	21
Total funding target for all participants	2017-12-31	309,684
Balance at beginning of prior year after applicable adjustments	2017-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2017-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2017-12-31	0
Prefunding balanced used to offset prior years funding requirement	2017-12-31	0
Amount remaining of carryover balance	2017-12-31	0
Amount remaining of prefunding balance	2017-12-31	0
Present value of excess contributions	2017-12-31	72,555
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2017-12-31	72,555
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2017-12-31	0
Reductions in caryover balances due to elections or deemed elections	2017-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2017-12-31	0
Balance of carryovers at beginning of current year	2017-12-31	0
Balance of prefunding at beginning of current year	2017-12-31	0
Total employer contributions	2017-12-31	130,491
Total employee contributions	2017-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2017-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2017-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2017-12-31	126,082
Unpaid minimum required contributions for all prior years	2017-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2017-12-31	0
Remaining amount of unpaid minimum required contributions	2017-12-31	0
Minimum required contributions for current year target normal cost	2017-12-31	61,671
Net shortfall amortization installment of oustanding balance	2017-12-31	0
Waiver amortization installment	2017-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2017-12-31	0
Additional cash requirement	2017-12-31	0
Contributions allocatedtoward minimum required contributions for current year	2017-12-31	126,082
Unpaid minimum required contributions for current year	2017-12-31	0
Unpaid minimum required contributions for all years	2017-12-31	0
2016: GOOD SAMARITAN MEDICAL CLINIC, INC. CASH BALANCE PENSION PLAN 2016 401k membership
Market value of plan assets	2016-12-31	196,922
Acturial value of plan assets	2016-12-31	196,922
Funding target for retired participants and beneficiaries receiving payment	2016-12-31	0
Number of terminated vested participants	2016-12-31	1
Fundng target for terminated vested participants	2016-12-31	256
Active participant vested funding target	2016-12-31	151,172
Number of active participants	2016-12-31	15
Total funding liabilities for active participants	2016-12-31	151,391
Total participant count	2016-12-31	16
Total funding target for all participants	2016-12-31	151,647
Balance at beginning of prior year after applicable adjustments	2016-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2016-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2016-12-31	0
Prefunding balanced used to offset prior years funding requirement	2016-12-31	0
Amount remaining of carryover balance	2016-12-31	0
Amount remaining of prefunding balance	2016-12-31	0
Present value of excess contributions	2016-12-31	54,695
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2016-12-31	54,695
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2016-12-31	0
Reductions in caryover balances due to elections or deemed elections	2016-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2016-12-31	0
Balance of carryovers at beginning of current year	2016-12-31	0
Balance of prefunding at beginning of current year	2016-12-31	0
Total employer contributions	2016-12-31	163,387
Total employee contributions	2016-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2016-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2016-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2016-12-31	158,288
Unpaid minimum required contributions for all prior years	2016-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2016-12-31	0
Remaining amount of unpaid minimum required contributions	2016-12-31	0
Minimum required contributions for current year target normal cost	2016-12-31	131,008
Net shortfall amortization installment of oustanding balance	2016-12-31	0
Waiver amortization installment	2016-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2016-12-31	85,733
Additional cash requirement	2016-12-31	85,733
Contributions allocatedtoward minimum required contributions for current year	2016-12-31	158,288
Unpaid minimum required contributions for current year	2016-12-31	0
Unpaid minimum required contributions for all years	2016-12-31	0

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Company Name:	GOOD SAMARITAN MEDICAL CLINIC, INC.
Employer identification number (EIN):	481287468
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2023-01-01
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01
002	2016-01-01
002	2015-01-01