401k Plan data: PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST plan

PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST
Plan identification number	001

PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST 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

PLAZA SURGICAL MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name: PLAZA SURGICAL MEDICAL CENTER

Employer identification number (EIN): 562373885

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01 ALICIA ONTIVEROS 2022-06-28
001 2020-01-01 ALICIA ONTIVEROS 2021-07-19
001 2019-01-01 GINA ZAPANTA 2020-10-14
001 2018-01-01 GINA ZAPANTA 2019-05-03
001 2017-01-01 GINA ZAPANTA 2018-06-04
001 2016-01-01 GINA ZAPANTA 2017-07-18
001 2015-01-01 GINA ZAPANTA 2016-07-22
001 2014-01-01 GINA ZAPANTA 2015-07-21
001 2013-01-01 GINA ZAPANTA 2014-06-16
001 2012-01-01 PLAZA SURGICAL MEDICAL CENTER
001 2012-01-01 PLAZA SURGICAL MEDICAL CENTER
001 2011-01-01 GINA ZAPANTA 2015-03-17
001 2010-01-01 PLAZA SURGICAL MEDICAL CENTER 2011-07-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2021-01-01	ALICIA ONTIVEROS	2022-06-28
001	2020-01-01	ALICIA ONTIVEROS	2021-07-19
001	2019-01-01	GINA ZAPANTA	2020-10-14
001	2018-01-01	GINA ZAPANTA	2019-05-03
001	2017-01-01	GINA ZAPANTA	2018-06-04
001	2016-01-01	GINA ZAPANTA	2017-07-18
001	2015-01-01	GINA ZAPANTA	2016-07-22
001	2014-01-01	GINA ZAPANTA	2015-07-21
001	2013-01-01	GINA ZAPANTA	2014-06-16
001	2012-01-01	PLAZA SURGICAL MEDICAL CENTER
001	2012-01-01	PLAZA SURGICAL MEDICAL CENTER
001	2011-01-01	GINA ZAPANTA	2015-03-17
001	2010-01-01	PLAZA SURGICAL MEDICAL CENTER	2011-07-20

Plan Statistics for PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST

Measure Date Value
2012: PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 30
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 2
Total of all active and inactive participants 2012-01-01 32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 32
Number of participants with account balances 2012-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2012: PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	30
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	2
Total of all active and inactive participants	2012-01-01	32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	32
Number of participants with account balances	2012-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST

Measure	Date	Value
2012 : PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST 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	$255,655
Expenses. Total of all expenses incurred	2012-12-31	$8,795
Benefits paid (including direct rollovers)	2012-12-31	$6,471
Total plan assets at end of year	2012-12-31	$246,860
Total plan assets at beginning of year	2012-12-31	$0
Value of fidelity bond covering the plan	2012-12-31	$0
Total contributions received or receivable from participants	2012-12-31	$150,608
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	$51,135
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$246,860
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$246,860
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$0
Assets. Value of participant loans	2012-12-31	$5,954
Total contributions received or receivable from employer(s)	2012-12-31	$53,912
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	$2,324
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	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

Form 5500 Responses for PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST

2012: PLAZA SURGICAL MEDICAL CENTER 401(K) PROFIT SHARING PLAN & TRUST 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
2012-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

243220

Policy instance

Insurance contract or identification number	243220
Number of Individuals Covered	21
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $593
Total amount of fees paid to insurance company	USD $861
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $593
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	CONTRACT SERVICE FEES
Insurance broker organization code?	4
Insurance broker name	PAYCHEX SECURITIES CORP

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Company Name:	PLAZA SURGICAL MEDICAL CENTER
Employer identification number (EIN):	562373885
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)