401k Plan data: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN plan

DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 401k Plan overview

Plan Name	DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN
Plan identification number	001

DOUGLAS HINTZMAN D O EMPLOYEES 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. Plan covering Self-Employed individuals.

401k Sponsoring company profile

DOUGLAS HINTZMAN, D.O. has sponsored the creation of one or more 401k plans.

Company Name: DOUGLAS HINTZMAN, D.O.

Employer identification number (EIN): 382903088

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 DOUGLAS HINTZMAN 2016-07-28
001 2014-01-01
001 2013-01-01 DOUGLAS HINTZMAN, D.O.
001 2012-01-01 DOUGLAS HINTZMAN, D.O.
001 2011-01-01 DOUGLAS HINTZMAN, D.O.
001 2010-01-01 DOUGLAS HINTZMAN, D.O.
001 2009-01-01 DAWN FEIGHNER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2015-01-01	DOUGLAS HINTZMAN	2016-07-28
001	2014-01-01
001	2013-01-01	DOUGLAS HINTZMAN, D.O.
001	2012-01-01	DOUGLAS HINTZMAN, D.O.
001	2011-01-01	DOUGLAS HINTZMAN, D.O.
001	2010-01-01	DOUGLAS HINTZMAN, D.O.
001	2009-01-01	DAWN FEIGHNER

Plan Statistics for DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN

401k plan membership statisitcs for DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN

Measure Date Value
2013: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2
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 1
Total of all active and inactive participants 2013-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 3
Number of participants with account balances 2013-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2
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 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 3
Number of participants with account balances 2012-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 3
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 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 3
Number of participants with account balances 2011-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 3
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 3
Number of participants with account balances 2010-01-01 3
2009: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 3
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 0
Total of all active and inactive participants 2009-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 3
Number of participants with account balances 2009-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2013: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2
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	1
Total of all active and inactive participants	2013-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	3
Number of participants with account balances	2013-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2
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	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	3
Number of participants with account balances	2012-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3
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	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	3
Number of participants with account balances	2011-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	3
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	3
Number of participants with account balances	2010-01-01	3
2009: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	3
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	0
Total of all active and inactive participants	2009-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	3
Number of participants with account balances	2009-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN

Measure	Date	Value
2013 : DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$53,244
Expenses. Total of all expenses incurred	2013-12-31	$829,014
Benefits paid (including direct rollovers)	2013-12-31	$820,917
Total plan assets at end of year	2013-12-31	$892,393
Total plan assets at beginning of year	2013-12-31	$1,668,163
Other income received	2013-12-31	$-3,054
Net income (gross income less expenses)	2013-12-31	$-775,770
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$892,393
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,668,163
Total contributions received or receivable from employer(s)	2013-12-31	$56,298
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$8,097
2012 : DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$175,562
Expenses. Total of all expenses incurred	2012-12-31	$9,418
Total plan assets at end of year	2012-12-31	$1,668,163
Total plan assets at beginning of year	2012-12-31	$1,502,019
Other income received	2012-12-31	$119,554
Net income (gross income less expenses)	2012-12-31	$166,144
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,668,163
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,502,019
Total contributions received or receivable from employer(s)	2012-12-31	$56,008
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$9,418
2011 : DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$130,816
Expenses. Total of all expenses incurred	2011-12-31	$8,695
Total plan assets at end of year	2011-12-31	$1,502,019
Total plan assets at beginning of year	2011-12-31	$1,379,898
Expenses. Other expenses not covered elsewhere	2011-12-31	$8,695
Other income received	2011-12-31	$75,148
Net income (gross income less expenses)	2011-12-31	$122,121
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,502,019
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,379,898
Total contributions received or receivable from employer(s)	2011-12-31	$55,668
2010 : DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$157,418
Expenses. Total of all expenses incurred	2010-12-31	$7,935
Total plan assets at end of year	2010-12-31	$1,379,898
Total plan assets at beginning of year	2010-12-31	$1,230,415
Expenses. Other expenses not covered elsewhere	2010-12-31	$7,935
Other income received	2010-12-31	$101,846
Net income (gross income less expenses)	2010-12-31	$149,483
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,379,898
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,230,415
Total contributions received or receivable from employer(s)	2010-12-31	$55,572

Form 5500 Responses for DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN

2013: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: DOUGLAS HINTZMAN D O EMPLOYEES PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: DOUGLAS HINTZMAN D O EMPLOYEES 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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	DOUGLAS HINTZMAN, D.O.
Employer identification number (EIN):	382903088
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)