401k Plan data: SANDRA C. KELLETT, O.D. 401(K) PLAN plan

SANDRA C. KELLETT, O.D. 401(K) PLAN 401k Plan overview

Plan Name	SANDRA C. KELLETT, O.D. 401(K) PLAN
Plan identification number	001

SANDRA C. KELLETT, O.D. 401(K) 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.
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.
Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

SANDRA C. KELLETT, O.D. has sponsored the creation of one or more 401k plans.

Company Name: SANDRA C. KELLETT, O.D.

Employer identification number (EIN): 134165824

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SANDRA C. KELLETT, O.D. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01 SANDRA KELLETT 2024-04-24
001 2022-01-01 SANDRA KELLETT 2023-08-15
001 2021-01-01 SANDRA KELLETT 2022-07-07
001 2020-01-01 SANDRA KELLETT 2021-05-14
001 2019-01-01
001 2018-01-01 SANDRA KELLETT 2019-05-20
001 2017-01-01 SANDRA KELLETT 2018-06-01
001 2016-01-01 SANDRA KELLETT 2017-05-12
001 2015-01-01 SANDRA KELLETT 2016-04-20
001 2014-01-01 SANDRA KELLETT 2015-05-29
001 2013-01-01 SANDRA KELLETT 2014-04-18
001 2012-01-01 SANDRA KELLETT 2013-06-05
001 2011-01-01 SANDRA KELLETT 2012-05-24
001 2010-01-01 SANDRA KELLETT 2011-05-17
001 2007-01-01 SANDRA KELLETT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2023-01-01	SANDRA KELLETT	2024-04-24
001	2022-01-01	SANDRA KELLETT	2023-08-15
001	2021-01-01	SANDRA KELLETT	2022-07-07
001	2020-01-01	SANDRA KELLETT	2021-05-14
001	2019-01-01
001	2018-01-01	SANDRA KELLETT	2019-05-20
001	2017-01-01	SANDRA KELLETT	2018-06-01
001	2016-01-01	SANDRA KELLETT	2017-05-12
001	2015-01-01	SANDRA KELLETT	2016-04-20
001	2014-01-01	SANDRA KELLETT	2015-05-29
001	2013-01-01	SANDRA KELLETT	2014-04-18
001	2012-01-01	SANDRA KELLETT	2013-06-05
001	2011-01-01	SANDRA KELLETT	2012-05-24
001	2010-01-01	SANDRA KELLETT	2011-05-17
001	2007-01-01	SANDRA KELLETT

Plan Statistics for SANDRA C. KELLETT, O.D. 401(K) PLAN

401k plan membership statisitcs for SANDRA C. KELLETT, O.D. 401(K) PLAN

Measure Date Value
2007: SANDRA C. KELLETT, O.D. 401(K) PLAN 2007 401k membership
Total participants, beginning-of-year 2007-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 6
Number of other retired or separated participants entitled to future benefits 2007-01-01 1
Total of all active and inactive participants 2007-01-01 7
Total participants 2007-01-01 7
Number of participants with account balances 2007-01-01 6

Measure	Date	Value
2007: SANDRA C. KELLETT, O.D. 401(K) PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	6
Number of other retired or separated participants entitled to future benefits	2007-01-01	1
Total of all active and inactive participants	2007-01-01	7
Total participants	2007-01-01	7
Number of participants with account balances	2007-01-01	6

Financial Data on SANDRA C. KELLETT, O.D. 401(K) PLAN

Measure	Date	Value
2007 : SANDRA C. KELLETT, O.D. 401(K) PLAN 2007 401k financial data
Total income from all sources	2007-12-31	$92,892
Total plan assets at end of year	2007-12-31	$479,230
Total plan assets at beginning of year	2007-12-31	$386,338
Total contributions received or receivable from participants	2007-12-31	$18,549
Other income received	2007-12-31	$32,829
Net income (gross income less expenses)	2007-12-31	$92,892
Net plan assets at end of year (total assets less liabilities)	2007-12-31	$479,230
Net plan assets at beginning of year (total assets less liabilities)	2007-12-31	$386,338
Total contributions received or receivable from employer(s)	2007-12-31	$41,514

Form 5500 Responses for SANDRA C. KELLETT, O.D. 401(K) PLAN

2007: SANDRA C. KELLETT, O.D. 401(K) PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-64-HF43

Policy instance

Insurance contract or identification number	GAP-64-HF43
Number of Individuals Covered	6
Insurance policy start date	2007-01-01
Insurance policy end date	2007-12-31
Total amount of commissions paid to insurance broker	USD $1,867
Total amount of fees paid to insurance company	USD $443
Commission paid to Insurance Broker	USD $1,487
Insurance broker organization code?	3
Amount paid for insurance broker fees	443
Additional information about fees paid to insurance broker	SUPPORT SERVICES
Insurance broker name	UNITED BENEFIT PENSIONS INC.

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Company Name:	SANDRA C. KELLETT, O.D.
Employer identification number (EIN):	134165824
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)