401k Plan data: AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN plan

AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN
Plan identification number	001

AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS 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.
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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

AMERICAN AMBULETTE AND AMBULANCE SERVICE, INC. has sponsored the creation of one or more 401k plans.

Company Name: AMERICAN AMBULETTE AND AMBULANCE SERVICE, INC.

Employer identification number (EIN): 310995916

NAIC Classification: 485990

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 ALGERNON BUTLER CH 7 TRUSTEE 2016-07-15
001 2015-01-01 AL BUTLER, CH. 7 TRUSTEE 2016-06-27
001 2014-01-01 ALGERNON BUTLER 2015-10-02
001 2013-01-01 ALGERNON L. BUTLER, III
001 2012-01-01 ALGERNON L. BUTLER, III
001 2011-01-01 JESSICA E. SIETSEMA 2012-09-04
001 2010-01-01 JESSICA E. SIETSEMA 2011-07-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2016-01-01	ALGERNON BUTLER CH 7 TRUSTEE	2016-07-15
001	2015-01-01	AL BUTLER, CH. 7 TRUSTEE	2016-06-27
001	2014-01-01	ALGERNON BUTLER	2015-10-02
001	2013-01-01	ALGERNON L. BUTLER, III
001	2012-01-01	ALGERNON L. BUTLER, III
001	2011-01-01	JESSICA E. SIETSEMA	2012-09-04
001	2010-01-01	JESSICA E. SIETSEMA	2011-07-07

Plan Statistics for AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN

Measure Date Value
2013: AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 601
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 51
Total of all active and inactive participants 2013-01-01 51
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 51
Number of participants with account balances 2013-01-01 51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 452
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 591
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 10
Total of all active and inactive participants 2012-01-01 601
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 601
Number of participants with account balances 2012-01-01 51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2013: AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	601
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	51
Total of all active and inactive participants	2013-01-01	51
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	51
Number of participants with account balances	2013-01-01	51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	452
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	591
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	10
Total of all active and inactive participants	2012-01-01	601
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	601
Number of participants with account balances	2012-01-01	51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN

Measure	Date	Value
2013 : AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$144,921
Total of all expenses incurred	2013-12-31	$129,620
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$120,029
Expenses. Certain deemed distributions of participant loans	2013-12-31	$3,113
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$103,416
Value of total assets at end of year	2013-12-31	$252,308
Value of total assets at beginning of year	2013-12-31	$237,007
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$6,478
Total interest from all sources	2013-12-31	$95
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$50,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$78,196
Participant contributions at beginning of year	2013-12-31	$893
Assets. Other investments not covered elsewhere at end of year	2013-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2013-12-31	$130,813
Other income not declared elsewhere	2013-12-31	$13
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$15,301
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$252,308
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$237,007
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$249,443
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$103,248
Interest on participant loans	2013-12-31	$95
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$2,865
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$2,053
Net investment gain/loss from pooled separate accounts	2013-12-31	$41,397
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$25,220
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$120,029
Contract administrator fees	2013-12-31	$6,478
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-12-31	No
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	WILLIAMS OVERMAN PIERCE, LLP
Accountancy firm EIN	2013-12-31	561031342
2012 : AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$-29,780
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$3,333
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$710
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$79,357
Value of total assets at end of year	2012-12-31	$237,007
Value of total assets at beginning of year	2012-12-31	$270,120
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$2,623
Total interest from all sources	2012-12-31	$-115,433
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$50,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$79,357
Participant contributions at end of year	2012-12-31	$893
Assets. Other investments not covered elsewhere at end of year	2012-12-31	$130,813
Other income not declared elsewhere	2012-12-31	$5
Total non interest bearing cash at beginning of year	2012-12-31	$270,120
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-33,113
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$237,007
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$270,120
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$103,248
Interest on participant loans	2012-12-31	$-115,433
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$2,053
Net investment gain/loss from pooled separate accounts	2012-12-31	$6,291
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$710
Contract administrator fees	2012-12-31	$2,623
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	No
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	WILLIAMS OVERMAN PIERCE, LLP
Accountancy firm EIN	2012-12-31	561031342

Form 5500 Responses for AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN

2013: AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: AMBULANCE HOLDINGS 401(K) RETIREMENT SAVINGS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
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

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

802461

Policy instance

Insurance contract or identification number	802461
Total amount of commissions paid to insurance broker	USD $1,312
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $1,312
Insurance broker name	WELLS FARGO WEALTH BROKERS

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

802461

Policy instance

Insurance contract or identification number	802461
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $671
Total amount of fees paid to insurance company	USD $0
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?	No
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
Number of Individuals Covered	51
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $638
Insurance broker organization code?	3
Insurance broker name	LOCKTON FINANCIAL ADVISORS LLC

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Company Name:	AMERICAN AMBULETTE AND AMBULANCE SERVICE, INC.
Employer identification number (EIN):	310995916
NAIC Classification:	485990