401k Plan data: RICHARD H. DUBOU, MD PENSION PLAN plan

RICHARD H. DUBOU, MD PENSION PLAN 401k Plan overview

Plan Name	RICHARD H. DUBOU, MD PENSION PLAN
Plan identification number	002

RICHARD H. DUBOU, MD PENSION PLAN 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

RICHARD H. DUBOU, MD has sponsored the creation of one or more 401k plans.

Company Name: RICHARD H. DUBOU, MD

Employer identification number (EIN): 610989587

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RICHARD H. DUBOU, MD PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01
002 2015-01-01
002 2014-01-01
002 2013-01-01
002 2012-01-01 RICHARD DUBOU
002 2011-01-01 RICHARD DUBOU

Plan Statistics for RICHARD H. DUBOU, MD PENSION PLAN

401k plan membership statisitcs for RICHARD H. DUBOU, MD PENSION PLAN

Measure Date Value
2012: RICHARD H. DUBOU, MD PENSION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 5
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 0
Total of all active and inactive participants 2012-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 5
Number of participants with account balances 2012-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: RICHARD H. DUBOU, MD PENSION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 3
Total of all active and inactive participants 2011-01-01 3
Total participants 2011-01-01 3
Number of participants with account balances 2011-01-01 3

Measure	Date	Value
2012: RICHARD H. DUBOU, MD PENSION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	5
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	0
Total of all active and inactive participants	2012-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	5
Number of participants with account balances	2012-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: RICHARD H. DUBOU, MD PENSION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3
Total of all active and inactive participants	2011-01-01	3
Total participants	2011-01-01	3
Number of participants with account balances	2011-01-01	3

Financial Data on RICHARD H. DUBOU, MD PENSION PLAN

Measure	Date	Value
2012 : RICHARD H. DUBOU, MD PENSION PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$27,710
Expenses. Total of all expenses incurred	2012-12-31	$44,197
Benefits paid (including direct rollovers)	2012-12-31	$44,197
Total plan assets at end of year	2012-12-31	$517,960
Total plan assets at beginning of year	2012-12-31	$534,447
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$27,710
Net income (gross income less expenses)	2012-12-31	$-16,487
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$517,960
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$534,447
Assets. Value of participant loans	2012-12-31	$47,799
Total contributions received or receivable from employer(s)	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
2011 : RICHARD H. DUBOU, MD PENSION PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$3,207
Expenses. Total of all expenses incurred	2011-12-31	$150
Total plan assets at end of year	2011-12-31	$534,447
Total plan assets at beginning of year	2011-12-31	$531,390
Other income received	2011-12-31	$3,207
Net income (gross income less expenses)	2011-12-31	$3,057
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$534,447
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$531,390
Assets. Value of participant loans	2011-12-31	$45,000
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$150

Form 5500 Responses for RICHARD H. DUBOU, MD PENSION PLAN

2012: RICHARD H. DUBOU, MD PENSION PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: RICHARD H. DUBOU, MD PENSION PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	RICHARD H. DUBOU, MD
Employer identification number (EIN):	610989587
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Plan id#	Filing Submission Date	Name of Administrator
002	2016-01-01
002	2015-01-01
002	2014-01-01
002	2013-01-01
002	2012-01-01	RICHARD DUBOU
002	2011-01-01	RICHARD DUBOU