401k Plan data: JACK B. KISTLER, M.D. INC. plan

JACK B. KISTLER, M.D. INC. 401k Plan overview

Plan Name	JACK B. KISTLER, M.D. INC.
Plan identification number	001

JACK B. KISTLER, M.D. INC. Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Plan covered by PBGC that was terminated and closed out for PBGC purposes - Before the end of the plan year (or a prior plan year), (1) the plan terminated in a standard (or distress) termination and completed the distribution of plan assets in satisfaction of all benefit liabilities (or all ERISA Title IV benefits for distress termination); or (2) a trustee was appointed for a terminated plan pursuant to ERISA section 4042.
Profit-sharing

401k Sponsoring company profile

JACK B. KISTLER, M.D., INC. has sponsored the creation of one or more 401k plans.

Company Name: JACK B. KISTLER, M.D., INC.

Employer identification number (EIN): 953571012

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JACK B. KISTLER, M.D. INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-09-01 PHILIP LIBERATORE
001 2014-09-01 PHILIP LIBERATORE
001 2014-09-01 PHILIP LIBERATORE
001 2014-09-01 PHILIP LIBERATORE
001 2013-09-01 PHILIP LIBERATORE
001 2012-09-01 JACK B. KISTLER JACK B. KISTLER 2014-02-28
001 2011-09-01 JACK KISTLER
001 2009-09-01 JACK B KISTLER

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2015-09-01	PHILIP LIBERATORE
001	2014-09-01	PHILIP LIBERATORE
001	2014-09-01	PHILIP LIBERATORE
001	2014-09-01	PHILIP LIBERATORE
001	2013-09-01	PHILIP LIBERATORE
001	2012-09-01	JACK B. KISTLER	JACK B. KISTLER	2014-02-28
001	2011-09-01	JACK KISTLER
001	2009-09-01	JACK B KISTLER

Plan Statistics for JACK B. KISTLER, M.D. INC.

401k plan membership statisitcs for JACK B. KISTLER, M.D. INC.

Measure Date Value
2015: JACK B. KISTLER, M.D. INC. 2015 401k membership
Total participants, beginning-of-year 2015-09-01 1
Total of all active and inactive participants 2015-09-01 0
Total participants 2015-09-01 0
2014: JACK B. KISTLER, M.D. INC. 2014 401k membership
Total participants, beginning-of-year 2014-09-01 1
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 1
Total of all active and inactive participants 2014-09-01 1
Total participants 2014-09-01 1
Number of participants with account balances 2014-09-01 1
2013: JACK B. KISTLER, M.D. INC. 2013 401k membership
Total participants, beginning-of-year 2013-09-01 1
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 1
Total of all active and inactive participants 2013-09-01 1
Total participants 2013-09-01 1
2012: JACK B. KISTLER, M.D. INC. 2012 401k membership
Total participants, beginning-of-year 2012-09-01 2
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 1
Total of all active and inactive participants 2012-09-01 1
Total participants 2012-09-01 1
2011: JACK B. KISTLER, M.D. INC. 2011 401k membership
Total participants, beginning-of-year 2011-09-01 2
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 1
Total of all active and inactive participants 2011-09-01 1
Total participants 2011-09-01 1
2009: JACK B. KISTLER, M.D. INC. 2009 401k membership
Total participants, beginning-of-year 2009-09-01 2
Total number of active participants reported on line 7a of the Form 5500 2009-09-01 2
Total of all active and inactive participants 2009-09-01 2
Total participants 2009-09-01 2

Measure	Date	Value
2015: JACK B. KISTLER, M.D. INC. 2015 401k membership
Total participants, beginning-of-year	2015-09-01	1
Total of all active and inactive participants	2015-09-01	0
Total participants	2015-09-01	0
2014: JACK B. KISTLER, M.D. INC. 2014 401k membership
Total participants, beginning-of-year	2014-09-01	1
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	1
Total of all active and inactive participants	2014-09-01	1
Total participants	2014-09-01	1
Number of participants with account balances	2014-09-01	1
2013: JACK B. KISTLER, M.D. INC. 2013 401k membership
Total participants, beginning-of-year	2013-09-01	1
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	1
Total of all active and inactive participants	2013-09-01	1
Total participants	2013-09-01	1
2012: JACK B. KISTLER, M.D. INC. 2012 401k membership
Total participants, beginning-of-year	2012-09-01	2
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	1
Total of all active and inactive participants	2012-09-01	1
Total participants	2012-09-01	1
2011: JACK B. KISTLER, M.D. INC. 2011 401k membership
Total participants, beginning-of-year	2011-09-01	2
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	1
Total of all active and inactive participants	2011-09-01	1
Total participants	2011-09-01	1
2009: JACK B. KISTLER, M.D. INC. 2009 401k membership
Total participants, beginning-of-year	2009-09-01	2
Total number of active participants reported on line 7a of the Form 5500	2009-09-01	2
Total of all active and inactive participants	2009-09-01	2
Total participants	2009-09-01	2

Financial Data on JACK B. KISTLER, M.D. INC.

Measure	Date	Value
2016 : JACK B. KISTLER, M.D. INC. 2016 401k financial data
Total income from all sources	2016-08-31	$0
Expenses. Total of all expenses incurred	2016-08-31	$235,167
Benefits paid (including direct rollovers)	2016-08-31	$235,167
Total plan assets at end of year	2016-08-31	$0
Total plan assets at beginning of year	2016-08-31	$235,167
Net income (gross income less expenses)	2016-08-31	$-235,167
Net plan assets at end of year (total assets less liabilities)	2016-08-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-08-31	$235,167
2015 : JACK B. KISTLER, M.D. INC. 2015 401k financial data
Total income from all sources	2015-08-31	$38,953
Expenses. Total of all expenses incurred	2015-08-31	$1,080,262
Benefits paid (including direct rollovers)	2015-08-31	$1,080,262
Total plan assets at end of year	2015-08-31	$235,167
Total plan assets at beginning of year	2015-08-31	$1,276,476
Other income received	2015-08-31	$38,953
Net income (gross income less expenses)	2015-08-31	$-1,041,309
Net plan assets at end of year (total assets less liabilities)	2015-08-31	$235,167
Net plan assets at beginning of year (total assets less liabilities)	2015-08-31	$1,276,476
2014 : JACK B. KISTLER, M.D. INC. 2014 401k financial data
Total income from all sources	2014-08-31	$19,452
Expenses. Total of all expenses incurred	2014-08-31	$50,000
Benefits paid (including direct rollovers)	2014-08-31	$50,000
Total plan assets at end of year	2014-08-31	$1,276,476
Total plan assets at beginning of year	2014-08-31	$1,307,024
Other income received	2014-08-31	$19,452
Net income (gross income less expenses)	2014-08-31	$-30,548
Net plan assets at end of year (total assets less liabilities)	2014-08-31	$1,276,476
Net plan assets at beginning of year (total assets less liabilities)	2014-08-31	$1,307,024
2013 : JACK B. KISTLER, M.D. INC. 2013 401k financial data
Total income from all sources	2013-08-31	$44,302
Expenses. Total of all expenses incurred	2013-08-31	$34,000
Benefits paid (including direct rollovers)	2013-08-31	$34,000
Total plan assets at end of year	2013-08-31	$1,307,024
Total plan assets at beginning of year	2013-08-31	$1,296,722
Other income received	2013-08-31	$14,302
Net income (gross income less expenses)	2013-08-31	$10,302
Net plan assets at end of year (total assets less liabilities)	2013-08-31	$1,307,024
Net plan assets at beginning of year (total assets less liabilities)	2013-08-31	$1,296,722
Total contributions received or receivable from employer(s)	2013-08-31	$30,000
2012 : JACK B. KISTLER, M.D. INC. 2012 401k financial data
Total income from all sources	2012-08-31	$7,389
Expenses. Total of all expenses incurred	2012-08-31	$34,000
Benefits paid (including direct rollovers)	2012-08-31	$34,000
Total plan assets at end of year	2012-08-31	$1,296,722
Total plan assets at beginning of year	2012-08-31	$1,323,333
Other income received	2012-08-31	$7,389
Net income (gross income less expenses)	2012-08-31	$-26,611
Net plan assets at end of year (total assets less liabilities)	2012-08-31	$1,296,722
Net plan assets at beginning of year (total assets less liabilities)	2012-08-31	$1,323,333
2011 : JACK B. KISTLER, M.D. INC. 2011 401k financial data
Total income from all sources	2011-08-31	$101,099
Expenses. Total of all expenses incurred	2011-08-31	$34,000
Benefits paid (including direct rollovers)	2011-08-31	$34,000
Total plan assets at end of year	2011-08-31	$1,323,333
Total plan assets at beginning of year	2011-08-31	$1,256,234
Value of fidelity bond covering the plan	2011-08-31	$200,000
Other income received	2011-08-31	$11,099
Net income (gross income less expenses)	2011-08-31	$67,099
Net plan assets at end of year (total assets less liabilities)	2011-08-31	$1,323,333
Net plan assets at beginning of year (total assets less liabilities)	2011-08-31	$1,256,234
Total contributions received or receivable from employer(s)	2011-08-31	$90,000

Form 5500 Responses for JACK B. KISTLER, M.D. INC.

2015: JACK B. KISTLER, M.D. INC. 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Submission has been amended	No
2015-09-01	This submission is the final filing	Yes
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-09-01	Plan is a collectively bargained plan	No
2015-09-01	Plan funding arrangement – Trust	Yes
2015-09-01	Plan benefit arrangement - Trust	Yes
2014: JACK B. KISTLER, M.D. INC. 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Submission has been amended	Yes
2014-09-01	This submission is the final filing	No
2014-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-09-01	Plan is a collectively bargained plan	No
2014-09-01	Plan funding arrangement – Trust	Yes
2014-09-01	Plan benefit arrangement - Trust	Yes
2013: JACK B. KISTLER, M.D. INC. 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Submission has been amended	No
2013-09-01	This submission is the final filing	No
2013-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-09-01	Plan is a collectively bargained plan	No
2013-09-01	Plan funding arrangement – Trust	Yes
2013-09-01	Plan benefit arrangement - Trust	Yes
2012: JACK B. KISTLER, M.D. INC. 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Plan funding arrangement – Trust	Yes
2012-09-01	Plan benefit arrangement - Trust	Yes
2011: JACK B. KISTLER, M.D. INC. 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Plan funding arrangement – Trust	Yes
2011-09-01	Plan benefit arrangement - Trust	Yes
2009: JACK B. KISTLER, M.D. INC. 2009 form 5500 responses
2009-09-01	Type of plan entity	Single employer plan
2009-09-01	Plan funding arrangement – Trust	Yes
2009-09-01	Plan benefit arrangement - Trust	Yes

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Company Name:	JACK B. KISTLER, M.D., INC.
Employer identification number (EIN):	953571012
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)