401k Plan data: URGENT CARE NW 401K PROFIT SHARING PLAN plan

URGENT CARE NW 401K PROFIT SHARING PLAN 401k Plan overview

Plan Name	URGENT CARE NW 401K PROFIT SHARING PLAN
Plan identification number	001

URGENT CARE NW 401K PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
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

URGENT CARE NW - GRESHAM P.C. has sponsored the creation of one or more 401k plans.

Company Name: URGENT CARE NW - GRESHAM P.C.

Employer identification number (EIN): 931173461

NAIC Classification: 621399
NAIC Description: Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan URGENT CARE NW 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 GREGORY CARROLL, MD 2015-10-09
001 2013-01-01 GREGORY CARROLL, MD 2014-10-06
001 2012-01-01 KEITH KLATT 2013-09-20
001 2011-01-01 KEITH KLATT
001 2009-01-01 KEITH KLATT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2014-01-01	GREGORY CARROLL, MD	2015-10-09
001	2013-01-01	GREGORY CARROLL, MD	2014-10-06
001	2012-01-01	KEITH KLATT	2013-09-20
001	2011-01-01	KEITH KLATT
001	2009-01-01	KEITH KLATT

Plan Statistics for URGENT CARE NW 401K PROFIT SHARING PLAN

401k plan membership statisitcs for URGENT CARE NW 401K PROFIT SHARING PLAN

Measure Date Value
2011: URGENT CARE NW 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 70
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 24
Total of all active and inactive participants 2011-01-01 94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 94
Number of participants with account balances 2011-01-01 58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: URGENT CARE NW 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 86
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 68
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 14
Total of all active and inactive participants 2009-01-01 82
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 82
Number of participants with account balances 2009-01-01 55
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 2

Measure	Date	Value
2011: URGENT CARE NW 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	70
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	24
Total of all active and inactive participants	2011-01-01	94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	94
Number of participants with account balances	2011-01-01	58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: URGENT CARE NW 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	86
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	68
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	14
Total of all active and inactive participants	2009-01-01	82
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	82
Number of participants with account balances	2009-01-01	55
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	2

Financial Data on URGENT CARE NW 401K PROFIT SHARING PLAN

Measure	Date	Value
2011 : URGENT CARE NW 401K PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$159,385
Expenses. Total of all expenses incurred	2011-12-31	$28,701
Benefits paid (including direct rollovers)	2011-12-31	$21,738
Total plan assets at end of year	2011-12-31	$1,550,361
Total plan assets at beginning of year	2011-12-31	$1,419,677
Value of fidelity bond covering the plan	2011-12-31	$110,000
Total contributions received or receivable from participants	2011-12-31	$145,364
Noncash contributions received	2011-12-31	$-57,801
Net income (gross income less expenses)	2011-12-31	$130,684
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,550,361
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,419,677
Assets. Value of participant loans	2011-12-31	$3,840
Assets. Value of real-estate (other than employer real property)	2011-12-31	$195,594
Total contributions received or receivable from employer(s)	2011-12-31	$71,822
Value of certain deemed distributions of participant loans	2011-12-31	$6,863
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$100
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : URGENT CARE NW 401K PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$269,854
Expenses. Total of all expenses incurred	2010-12-31	$15,443
Benefits paid (including direct rollovers)	2010-12-31	$15,424
Total plan assets at end of year	2010-12-31	$1,419,677
Total plan assets at beginning of year	2010-12-31	$1,165,266
Value of fidelity bond covering the plan	2010-12-31	$80,000
Total contributions received or receivable from participants	2010-12-31	$118,880
Contributions received from other sources (not participants or employers)	2010-12-31	$232
Other income received	2010-12-31	$89,079
Net income (gross income less expenses)	2010-12-31	$254,411
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,419,677
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,165,266
Assets. Value of participant loans	2010-12-31	$7,070
Assets. Value of real-estate (other than employer real property)	2010-12-31	$196,594
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2010-12-31	$96,007
Total contributions received or receivable from employer(s)	2010-12-31	$61,663
Value of certain deemed distributions of participant loans	2010-12-31	$19
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : URGENT CARE NW 401K PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for URGENT CARE NW 401K PROFIT SHARING PLAN

2011: URGENT CARE NW 401K PROFIT SHARING 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
2009: URGENT CARE NW 401K PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	URGENT CARE NW - GRESHAM P.C.
Employer identification number (EIN):	931173461
NAIC Classification:	621399
NAIC Description:	Offices of All Other Miscellaneous Health Practitioners