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JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 401k Plan overview

Plan NameJEFFERSON UNDERWOOD, M.D. 401(K) PLAN
Plan identification number 001

JEFFERSON UNDERWOOD, M.D. 401(K) PLAN Benefits

401k Plan TypeDefined 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

JEFFERSON UNDERWOOD, M.D. has sponsored the creation of one or more 401k plans.

Company Name:JEFFERSON UNDERWOOD, M.D.
Employer identification number (EIN):630810269
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JEFFERSON UNDERWOOD, M.D. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012019-01-01JEFFERSON UNDERWOOD2020-06-11
0012018-01-01JEFFERSON UNDERWOOD2019-10-03
0012017-01-01JEFFERSON UNDERWOOD2018-07-23
0012016-01-01JEFFERSON UNDERWOOD2017-07-26
0012015-01-01JEFFERSON UNDERWOOD2016-06-14
0012014-01-01JEFFERSON UNDERWOOD
0012013-01-01JEFFERSON UNDERWOOD
0012012-01-01JEFFERSON UNDERWOOD
0012011-01-01JEFFERSON UNDERWOOD
0012010-01-01JEFFERSON UNDERWOOD
0012009-01-01JEFFERSON UNDERWOOD

Plan Statistics for JEFFERSON UNDERWOOD, M.D. 401(K) PLAN

401k plan membership statisitcs for JEFFERSON UNDERWOOD, M.D. 401(K) PLAN

Measure Date Value
2014: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-014
Total number of active participants reported on line 7a of the Form 55002014-01-013
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-011
Total of all active and inactive participants2014-01-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-014
Number of participants with account balances2014-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-014
Total number of active participants reported on line 7a of the Form 55002013-01-013
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-011
Total of all active and inactive participants2013-01-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-014
Number of participants with account balances2013-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-015
Total number of active participants reported on line 7a of the Form 55002012-01-014
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-014
Number of participants with account balances2012-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-015
Total number of active participants reported on line 7a of the Form 55002011-01-015
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-015
Number of participants with account balances2011-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-015
Total number of active participants reported on line 7a of the Form 55002010-01-015
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-015
Number of participants with account balances2010-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-015
Total number of active participants reported on line 7a of the Form 55002009-01-015
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-015
Number of participants with account balances2009-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on JEFFERSON UNDERWOOD, M.D. 401(K) PLAN

Measure Date Value
2014 : JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total income from all sources2014-12-31$34,239
Expenses. Total of all expenses incurred2014-12-31$100
Benefits paid (including direct rollovers)2014-12-31$0
Total plan assets at end of year2014-12-31$239,170
Total plan assets at beginning of year2014-12-31$205,031
Value of fidelity bond covering the plan2014-12-31$75,000
Total contributions received or receivable from participants2014-12-31$19,326
Expenses. Other expenses not covered elsewhere2014-12-31$100
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$5,287
Net income (gross income less expenses)2014-12-31$34,139
Net plan assets at end of year (total assets less liabilities)2014-12-31$239,170
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$205,031
Assets. Value of participant loans2014-12-31$0
Total contributions received or receivable from employer(s)2014-12-31$9,626
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
2013 : JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total income from all sources2013-12-31$47,090
Expenses. Total of all expenses incurred2013-12-31$100
Benefits paid (including direct rollovers)2013-12-31$0
Total plan assets at end of year2013-12-31$205,031
Total plan assets at beginning of year2013-12-31$158,041
Value of fidelity bond covering the plan2013-12-31$75,000
Total contributions received or receivable from participants2013-12-31$19,369
Expenses. Other expenses not covered elsewhere2013-12-31$100
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$18,052
Net income (gross income less expenses)2013-12-31$46,990
Net plan assets at end of year (total assets less liabilities)2013-12-31$205,031
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$158,041
Assets. Value of participant loans2013-12-31$0
Total contributions received or receivable from employer(s)2013-12-31$9,669
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
2012 : JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total income from all sources2012-12-31$45,966
Expenses. Total of all expenses incurred2012-12-31$6,413
Benefits paid (including direct rollovers)2012-12-31$6,294
Total plan assets at end of year2012-12-31$158,041
Total plan assets at beginning of year2012-12-31$118,488
Value of fidelity bond covering the plan2012-12-31$75,000
Total contributions received or receivable from participants2012-12-31$19,627
Expenses. Other expenses not covered elsewhere2012-12-31$119
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$15,912
Net income (gross income less expenses)2012-12-31$39,553
Net plan assets at end of year (total assets less liabilities)2012-12-31$158,041
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$118,488
Assets. Value of participant loans2012-12-31$0
Total contributions received or receivable from employer(s)2012-12-31$10,427
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Funding deficiency by the employer to the plan for this plan year2012-12-31$0
Minimum employer required contribution for this plan year2012-12-31$0
Amount contributed by the employer to the plan for this plan year2012-12-31$0
2011 : JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total income from all sources2011-12-31$27,346
Expenses. Total of all expenses incurred2011-12-31$125
Benefits paid (including direct rollovers)2011-12-31$0
Total plan assets at end of year2011-12-31$118,488
Total plan assets at beginning of year2011-12-31$91,267
Value of fidelity bond covering the plan2011-12-31$75,000
Total contributions received or receivable from participants2011-12-31$19,368
Expenses. Other expenses not covered elsewhere2011-12-31$125
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-2,690
Net income (gross income less expenses)2011-12-31$27,221
Net plan assets at end of year (total assets less liabilities)2011-12-31$118,488
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$91,267
Assets. Value of participant loans2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$10,668
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
2010 : JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total income from all sources2010-12-31$39,564
Expenses. Total of all expenses incurred2010-12-31$125
Benefits paid (including direct rollovers)2010-12-31$0
Total plan assets at end of year2010-12-31$91,267
Total plan assets at beginning of year2010-12-31$51,828
Value of fidelity bond covering the plan2010-12-31$75,000
Total contributions received or receivable from participants2010-12-31$19,246
Expenses. Other expenses not covered elsewhere2010-12-31$125
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$9,772
Net income (gross income less expenses)2010-12-31$39,439
Net plan assets at end of year (total assets less liabilities)2010-12-31$91,267
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$51,828
Assets. Value of participant loans2010-12-31$0
Total contributions received or receivable from employer(s)2010-12-31$10,546
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0

Form 5500 Responses for JEFFERSON UNDERWOOD, M.D. 401(K) PLAN

2014: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: JEFFERSON UNDERWOOD, M.D. 401(K) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-810885
Policy instance 1
Insurance contract or identification numberGA-810885
Number of Individuals Covered4
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,074
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $1,074
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN MUTUAL INVESTMENT
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-810885
Policy instance 1
Insurance contract or identification numberGA-810885
Number of Individuals Covered4
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $850
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $850
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN MUT INV SVC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-810885
Policy instance 1
Insurance contract or identification numberGA-810885
Number of Individuals Covered4
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $660
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $660
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN MUT INV SVC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-810885
Policy instance 1
Insurance contract or identification numberGA-810885
Number of Individuals Covered5
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $499
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 numberGA-810885
Policy instance 1
Insurance contract or identification numberGA-810885
Number of Individuals Covered5
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $301
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $301
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN MUT INV SVC

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