401k Plan data: LAWRENCE R. BLACK, D.O., P.A. 401(K) PROFIT SHARING PLAN & TRUST plan

LAWRENCE R. BLACK, D.O., P.A. 401(K) PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	LAWRENCE R. BLACK, D.O., P.A. 401(K) PROFIT SHARING PLAN & TRUST
Plan identification number	001

LAWRENCE R. BLACK, D.O., P.A. 401(K) PROFIT SHARING PLAN & TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Money purchase (other than target benefit)
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.

401k Sponsoring company profile

LAWRENCE R. BLACK, D.O., P.A. has sponsored the creation of one or more 401k plans.

Company Name: LAWRENCE R. BLACK, D.O., P.A.

Employer identification number (EIN): 593350266

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

Additional information about LAWRENCE R. BLACK, D.O., P.A.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 1995-12-21

Company Identification Number: P95000096577

Legal Registered Office Address: 13691 METRO PKWY S

FT MYERS

33912

More information about LAWRENCE R. BLACK, D.O., P.A.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAWRENCE R. BLACK, D.O., P.A. 401(K) PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 LAWRENCE R. BLACK, D.O. 2014-01-27 LAWRENCE R. BLACK, D.O. 2014-01-27
001 2012-01-01 LAWRENCE R. BLACK, D.O. 2013-06-07 LAWRENCE R. BLACK, D.O. 2013-06-07
001 2011-01-01 LAWRENCE R. BLACK, D.O. 2012-07-30 LAWRENCE R. BLACK, D.O. 2012-07-30
001 2010-01-01 LAWRENCE R. BLACK, D.O. 2011-05-20 LAWRENCE R. BLACK, D.O. 2011-05-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2013-01-01	LAWRENCE R. BLACK, D.O.	2014-01-27	LAWRENCE R. BLACK, D.O.	2014-01-27
001	2012-01-01	LAWRENCE R. BLACK, D.O.	2013-06-07	LAWRENCE R. BLACK, D.O.	2013-06-07
001	2011-01-01	LAWRENCE R. BLACK, D.O.	2012-07-30	LAWRENCE R. BLACK, D.O.	2012-07-30
001	2010-01-01	LAWRENCE R. BLACK, D.O.	2011-05-20	LAWRENCE R. BLACK, D.O.	2011-05-20

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Company Name:	LAWRENCE R. BLACK, D.O., P.A.
Employer identification number (EIN):	593350266
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	1995-12-21
Company Identification Number:	P95000096577
Legal Registered Office Address:	13691 METRO PKWY S FT MYERS 33912