401k Plan data: PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN plan

PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN
Plan identification number	001

PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan covering Self-Employed individuals.
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

PHILIP A. PENEPENT, JR. has sponsored the creation of one or more 401k plans.

Company Name: PHILIP A. PENEPENT, JR.

Employer identification number (EIN): 161201400

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01 PHILIP A. PENEPENT, JR., M.D. 2015-07-23
001 2013-01-01 PHILIP A. PENEPENT, JR., M.D. 2014-10-08
001 2012-01-01 PHILIP A. PENEPENT, JR., M.D.
001 2011-01-01 PHILIP A. PENEPENT, JR., M.D.
001 2009-01-01 PHILIP A. PENEPENT, M.D.

Plan Statistics for PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN

Measure Date Value
2012: PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 6
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 1
Total of all active and inactive participants 2012-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 7
Number of participants with account balances 2012-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 7
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 0
Total of all active and inactive participants 2011-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 7
Number of participants with account balances 2011-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 7
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 1
Total of all active and inactive participants 2009-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 8
Number of participants with account balances 2009-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2012: PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	6
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	1
Total of all active and inactive participants	2012-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	7
Number of participants with account balances	2012-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	7
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	0
Total of all active and inactive participants	2011-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	7
Number of participants with account balances	2011-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	7
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	1
Total of all active and inactive participants	2009-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	8
Number of participants with account balances	2009-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2012 : PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$314,682
Expenses. Total of all expenses incurred	2012-12-31	$64,613
Benefits paid (including direct rollovers)	2012-12-31	$60,000
Total plan assets at end of year	2012-12-31	$1,833,187
Total plan assets at beginning of year	2012-12-31	$1,583,118
Value of fidelity bond covering the plan	2012-12-31	$500,000
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	$245,500
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$250,069
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,833,187
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,583,118
Assets. Value of participant loans	2012-12-31	$19,774
Total contributions received or receivable from employer(s)	2012-12-31	$69,182
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$4,613
2011 : PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$2,568
Expenses. Total of all expenses incurred	2011-12-31	$31,410
Benefits paid (including direct rollovers)	2011-12-31	$27,254
Total plan assets at end of year	2011-12-31	$1,583,118
Total plan assets at beginning of year	2011-12-31	$1,611,960
Value of fidelity bond covering the plan	2011-12-31	$500,000
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-64,938
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-28,842
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,583,118
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,611,960
Assets. Value of participant loans	2011-12-31	$84,778
Total contributions received or receivable from employer(s)	2011-12-31	$67,506
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$4,156
2010 : PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$281,872
Expenses. Total of all expenses incurred	2010-12-31	$3,540
Total plan assets at end of year	2010-12-31	$1,611,960
Total plan assets at beginning of year	2010-12-31	$1,333,628
Value of fidelity bond covering the plan	2010-12-31	$150,000
Other income received	2010-12-31	$214,653
Net income (gross income less expenses)	2010-12-31	$278,332
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,611,960
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,333,628
Assets. Value of participant loans	2010-12-31	$107,679
Total contributions received or receivable from employer(s)	2010-12-31	$67,219
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$3,540
2009 : PHILIP A. PENEPENT 401(K) 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 PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN

2012: PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PHILIP A. PENEPENT 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: PHILIP A. PENEPENT 401(K) 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

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

81339

Policy instance

Insurance contract or identification number	81339
Number of Individuals Covered	7
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $8,429
Total amount of fees paid to insurance company	USD $841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

JOHN HANCOCK LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 86375 )

Policy contract number

81339

Policy instance

Insurance contract or identification number	81339
Number of Individuals Covered	7
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $7,260
Total amount of fees paid to insurance company	USD $542
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,157
Insurance broker organization code?	4
Amount paid for insurance broker fees	542
Additional information about fees paid to insurance broker	TPA COMPENSATION
Insurance broker name	PENSION SERVICES OF WNY INC

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Company Name:	PHILIP A. PENEPENT, JR.
Employer identification number (EIN):	161201400
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2023-01-01
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01	PHILIP A. PENEPENT, JR., M.D.	2015-07-23
001	2013-01-01	PHILIP A. PENEPENT, JR., M.D.	2014-10-08
001	2012-01-01	PHILIP A. PENEPENT, JR., M.D.
001	2011-01-01	PHILIP A. PENEPENT, JR., M.D.
001	2009-01-01	PHILIP A. PENEPENT, M.D.