401k Plan data: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC plan

PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 401k Plan overview

Plan Name	PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC
Plan identification number	002

PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 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

COASTAL EAR, NOSE & THROAT P.A. has sponsored the creation of one or more 401k plans.

Company Name: COASTAL EAR, NOSE & THROAT P.A.

Employer identification number (EIN): 541667820

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01 MICHAEL J. SAMSON MICHAEL J. SAMSON 2017-10-03
002 2015-01-01 MICHAEL J. SAMSON MICHAEL J. SAMSON 2016-09-13
002 2014-01-01 MICHAEL J. SAMSON MICHAEL J. SAMSON 2015-09-14
002 2013-01-01 MICHAEL J. SAMSON MICHAEL J. SAMSON 2014-09-10
002 2012-01-01 MICHAEL J. SAMSON MICHAEL J. SAMSON 2013-09-22
002 2011-01-01 MICHAEL J. SAMSON MICHAEL J. SAMSON 2012-09-15
002 2010-01-01 MICHAEL J. SAMSON MICHAEL J. SAMSON 2011-09-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2016-01-01	MICHAEL J. SAMSON	MICHAEL J. SAMSON	2017-10-03
002	2015-01-01	MICHAEL J. SAMSON	MICHAEL J. SAMSON	2016-09-13
002	2014-01-01	MICHAEL J. SAMSON	MICHAEL J. SAMSON	2015-09-14
002	2013-01-01	MICHAEL J. SAMSON	MICHAEL J. SAMSON	2014-09-10
002	2012-01-01	MICHAEL J. SAMSON	MICHAEL J. SAMSON	2013-09-22
002	2011-01-01	MICHAEL J. SAMSON	MICHAEL J. SAMSON	2012-09-15
002	2010-01-01	MICHAEL J. SAMSON	MICHAEL J. SAMSON	2011-09-13

Plan Statistics for PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC

401k plan membership statisitcs for PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC

Measure Date Value
2016: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2016 401k membership
Total participants, beginning-of-year 2016-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2015 401k membership
Total participants, beginning-of-year 2015-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 5
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 1
Total of all active and inactive participants 2015-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 6
Number of participants with account balances 2015-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2014 401k membership
Total participants, beginning-of-year 2014-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 5
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 6
Number of participants with account balances 2014-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2013 401k membership
Total participants, beginning-of-year 2013-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 5
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 7
Number of participants with account balances 2013-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2012 401k membership
Total participants, beginning-of-year 2012-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 5
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 1
Total of all active and inactive participants 2012-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 6
Number of participants with account balances 2012-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 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 5
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 1
Total of all active and inactive participants 2011-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 6
Number of participants with account balances 2011-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2010 401k membership
Total participants, beginning-of-year 2010-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 5
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 5
Number of participants with account balances 2010-01-01 5

Measure	Date	Value
2016: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2016 401k membership
Total participants, beginning-of-year	2016-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2015 401k membership
Total participants, beginning-of-year	2015-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	5
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	1
Total of all active and inactive participants	2015-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	6
Number of participants with account balances	2015-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2014 401k membership
Total participants, beginning-of-year	2014-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	5
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	6
Number of participants with account balances	2014-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2013 401k membership
Total participants, beginning-of-year	2013-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	5
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	7
Number of participants with account balances	2013-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2012 401k membership
Total participants, beginning-of-year	2012-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	5
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	1
Total of all active and inactive participants	2012-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	6
Number of participants with account balances	2012-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 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	5
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	1
Total of all active and inactive participants	2011-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	6
Number of participants with account balances	2011-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2010 401k membership
Total participants, beginning-of-year	2010-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	5
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	5
Number of participants with account balances	2010-01-01	5

Financial Data on PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC

Measure	Date	Value
2016 : PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2016 401k financial data
Total income from all sources	2016-12-31	$86,353
Expenses. Total of all expenses incurred	2016-12-31	$1,362,870
Benefits paid (including direct rollovers)	2016-12-31	$1,360,822
Total plan assets at end of year	2016-12-31	$0
Total plan assets at beginning of year	2016-12-31	$1,276,517
Other income received	2016-12-31	$86,353
Net income (gross income less expenses)	2016-12-31	$-1,276,517
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,276,517
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$2,048
2015 : PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2015 401k financial data
Total income from all sources	2015-12-31	$-8,150
Total plan assets at end of year	2015-12-31	$1,276,517
Total plan assets at beginning of year	2015-12-31	$1,284,667
Value of fidelity bond covering the plan	2015-12-31	$135,000
Other income received	2015-12-31	$-8,150
Net income (gross income less expenses)	2015-12-31	$-8,150
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,276,517
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,284,667
2014 : PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2014 401k financial data
Total income from all sources	2014-12-31	$167,881
Expenses. Total of all expenses incurred	2014-12-31	$7,090
Benefits paid (including direct rollovers)	2014-12-31	$7,090
Total plan assets at end of year	2014-12-31	$1,284,667
Total plan assets at beginning of year	2014-12-31	$1,123,876
Value of fidelity bond covering the plan	2014-12-31	$135,000
Total contributions received or receivable from participants	2014-12-31	$45,300
Other income received	2014-12-31	$79,735
Net income (gross income less expenses)	2014-12-31	$160,791
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,284,667
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,123,876
Total contributions received or receivable from employer(s)	2014-12-31	$42,846
2013 : PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2013 401k financial data
Total income from all sources	2013-12-31	$111,006
Total plan assets at end of year	2013-12-31	$1,123,876
Total plan assets at beginning of year	2013-12-31	$1,012,870
Value of fidelity bond covering the plan	2013-12-31	$130,000
Total contributions received or receivable from participants	2013-12-31	$45,325
Other income received	2013-12-31	$23,016
Net income (gross income less expenses)	2013-12-31	$111,006
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,123,876
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,012,870
Total contributions received or receivable from employer(s)	2013-12-31	$42,665
2012 : PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2012 401k financial data
Total income from all sources	2012-12-31	$119,225
Total plan assets at end of year	2012-12-31	$1,012,870
Total plan assets at beginning of year	2012-12-31	$893,645
Value of fidelity bond covering the plan	2012-12-31	$110,000
Total contributions received or receivable from participants	2012-12-31	$45,900
Other income received	2012-12-31	$33,245
Net income (gross income less expenses)	2012-12-31	$119,225
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,012,870
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$893,645
Total contributions received or receivable from employer(s)	2012-12-31	$40,080
2011 : PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2011 401k financial data
Total income from all sources	2011-12-31	$77,674
Expenses. Total of all expenses incurred	2011-12-31	$42,414
Benefits paid (including direct rollovers)	2011-12-31	$42,414
Total plan assets at end of year	2011-12-31	$893,645
Total plan assets at beginning of year	2011-12-31	$858,385
Value of fidelity bond covering the plan	2011-12-31	$95,000
Total contributions received or receivable from participants	2011-12-31	$41,125
Other income received	2011-12-31	$-4,233
Net income (gross income less expenses)	2011-12-31	$35,260
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$893,645
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$858,385
Total contributions received or receivable from employer(s)	2011-12-31	$40,782
2010 : PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2010 401k financial data
Total income from all sources	2010-12-31	$138,050
Total plan assets at end of year	2010-12-31	$858,385
Total plan assets at beginning of year	2010-12-31	$720,335
Value of fidelity bond covering the plan	2010-12-31	$120,000
Total contributions received or receivable from participants	2010-12-31	$39,125
Other income received	2010-12-31	$54,957
Net income (gross income less expenses)	2010-12-31	$138,050
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$858,385
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$720,335
Total contributions received or receivable from employer(s)	2010-12-31	$43,968

Form 5500 Responses for PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC

2016: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	This submission is the final filing	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: PROFIT SHARING PLAN OF MICHAEL J. SAMSON MD PC 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	COASTAL EAR, NOSE & THROAT P.A.
Employer identification number (EIN):	541667820
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)