401k Plan data: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN plan

BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 401k Plan overview

Plan Name	BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN
Plan identification number	001

BLUE SPRINGS FAMILY CARE, P. C. 401K 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.
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.

401k Sponsoring company profile

BLUE SPRINGS FAMILY CARE, P.C. has sponsored the creation of one or more 401k plans.

Company Name: BLUE SPRINGS FAMILY CARE, P.C.

Employer identification number (EIN): 431853801

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 JOHN PETERSON 2023-10-04
001 2021-01-01 JOHN PETERSON 2022-06-08 JOHN PETERSON 2022-06-08
001 2020-01-01 JOHN PETERSON 2021-08-24 JOHN PETERSON 2021-08-24
001 2019-01-01 JOHN PETERSON 2020-04-17 JOHN PETERSON 2020-04-17
001 2018-01-01 JOHN PETERSON 2019-05-29 JOHN PETERSON 2019-05-29
001 2017-01-01 JOHN PETERSON 2018-08-14 JOHN PETERSON 2018-08-14
001 2016-01-01 JOHN PETERSON 2017-10-13
001 2015-01-01 JOHN PETERSON 2016-06-01 JOHN PETERSON 2016-06-01
001 2014-01-01 JOHN PETERSON 2015-07-15 JOHN PETERSON 2015-07-15
001 2013-01-01 JOHN PETERSON 2014-10-15
001 2012-01-01 JOHN PETERSON JOHN PETERSON 2013-06-13
001 2011-01-01 JOHN PETERSON
001 2010-01-01 JOHN PETERSON JOHN PETERSON 2011-09-22
001 2009-01-01 JOHN PETERSON DO

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	JOHN PETERSON	2023-10-04
001	2021-01-01	JOHN PETERSON	2022-06-08	JOHN PETERSON	2022-06-08
001	2020-01-01	JOHN PETERSON	2021-08-24	JOHN PETERSON	2021-08-24
001	2019-01-01	JOHN PETERSON	2020-04-17	JOHN PETERSON	2020-04-17
001	2018-01-01	JOHN PETERSON	2019-05-29	JOHN PETERSON	2019-05-29
001	2017-01-01	JOHN PETERSON	2018-08-14	JOHN PETERSON	2018-08-14
001	2016-01-01	JOHN PETERSON	2017-10-13
001	2015-01-01	JOHN PETERSON	2016-06-01	JOHN PETERSON	2016-06-01
001	2014-01-01	JOHN PETERSON	2015-07-15	JOHN PETERSON	2015-07-15
001	2013-01-01	JOHN PETERSON	2014-10-15
001	2012-01-01	JOHN PETERSON		JOHN PETERSON	2013-06-13
001	2011-01-01	JOHN PETERSON
001	2010-01-01	JOHN PETERSON		JOHN PETERSON	2011-09-22
001	2009-01-01	JOHN PETERSON DO

Plan Statistics for BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN

401k plan membership statisitcs for BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN

Measure Date Value
2012: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 11
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 9
Total of all active and inactive participants 2012-01-01 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 20
Number of participants with account balances 2012-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 3
2011: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 30
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 12
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 14
Total of all active and inactive participants 2011-01-01 26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 26
Number of participants with account balances 2011-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 30
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 37
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 37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 37
Number of participants with account balances 2010-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 33
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 24
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 7
Total of all active and inactive participants 2009-01-01 31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 31
Number of participants with account balances 2009-01-01 31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2012: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	11
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	9
Total of all active and inactive participants	2012-01-01	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	20
Number of participants with account balances	2012-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	3
2011: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	30
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	12
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	14
Total of all active and inactive participants	2011-01-01	26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	26
Number of participants with account balances	2011-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	30
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	37
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	37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	37
Number of participants with account balances	2010-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	33
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	24
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	7
Total of all active and inactive participants	2009-01-01	31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	31
Number of participants with account balances	2009-01-01	31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN

Measure	Date	Value
2012 : BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$317,052
Expenses. Total of all expenses incurred	2012-12-31	$497,623
Benefits paid (including direct rollovers)	2012-12-31	$497,623
Total plan assets at end of year	2012-12-31	$1,358,628
Total plan assets at beginning of year	2012-12-31	$1,539,199
Value of fidelity bond covering the plan	2012-12-31	$10,000
Total contributions received or receivable from participants	2012-12-31	$75,175
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	$204,218
Net income (gross income less expenses)	2012-12-31	$-180,571
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,358,628
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,539,199
Assets. Value of participant loans	2012-12-31	$6,293
Total contributions received or receivable from employer(s)	2012-12-31	$37,659
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
2011 : BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$49,601
Expenses. Total of all expenses incurred	2011-12-31	$318,185
Benefits paid (including direct rollovers)	2011-12-31	$318,115
Total plan assets at end of year	2011-12-31	$1,539,199
Total plan assets at beginning of year	2011-12-31	$1,807,783
Value of fidelity bond covering the plan	2011-12-31	$10,000
Total contributions received or receivable from participants	2011-12-31	$123,973
Expenses. Other expenses not covered elsewhere	2011-12-31	$70
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-133,217
Net income (gross income less expenses)	2011-12-31	$-268,584
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,539,199
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,807,783
Assets. Value of participant loans	2011-12-31	$15,885
Total contributions received or receivable from employer(s)	2011-12-31	$58,845
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$433,494
Expenses. Total of all expenses incurred	2010-12-31	$5,484
Benefits paid (including direct rollovers)	2010-12-31	$5,414
Total plan assets at end of year	2010-12-31	$1,807,783
Total plan assets at beginning of year	2010-12-31	$1,379,773
Value of fidelity bond covering the plan	2010-12-31	$10,000
Total contributions received or receivable from participants	2010-12-31	$120,614
Expenses. Other expenses not covered elsewhere	2010-12-31	$70
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$246,684
Net income (gross income less expenses)	2010-12-31	$428,010
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,807,783
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,379,773
Assets. Value of participant loans	2010-12-31	$20,183
Total contributions received or receivable from employer(s)	2010-12-31	$66,196
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
2009 : BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN

2012: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: BLUE SPRINGS FAMILY CARE, P. C. 401K PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: BLUE SPRINGS FAMILY CARE, P. C. 401K 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

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-200151

Policy instance

Insurance contract or identification number	GA-200151
Number of Individuals Covered	11
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,657
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?	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 $5,657
Insurance broker organization code?	3
Insurance broker name	NATIONS FINANCIAL GROUP INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-200151

Policy instance

Insurance contract or identification number	GA-200151
Number of Individuals Covered	26
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,219
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?	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

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-200151

Policy instance

Insurance contract or identification number	GA-200151
Number of Individuals Covered	30
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,496
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?	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 $5,496
Insurance broker organization code?	3
Insurance broker name	NATIONS FINANCIAL GROUP INC

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Company Name:	BLUE SPRINGS FAMILY CARE, P.C.
Employer identification number (EIN):	431853801
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)