401k Plan data: SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN plan

SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 401k Plan overview

Plan Name	SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN
Plan identification number	001

SAMIR KASSICIEH, DO, PC 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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

KASMIR KASSICHIEH, DO, PC has sponsored the creation of one or more 401k plans.

Company Name: KASMIR KASSICHIEH, DO, PC

Employer identification number (EIN): 742836796

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 SAMIR KASSICIEH SAMIR KASSICIEH 2015-10-15
001 2013-01-01 SAMIR KASSICIEH SAMIR KASSICIEH 2014-09-09
001 2012-01-01 SAMIR KASSICIEH SAMIR KASSICIEH 2013-06-30
001 2011-01-01 SAMIR KASSICIEH SAMIR KASSICIEH 2012-10-11
001 2010-01-01 SAMIR KASSICIEH 2011-08-09 SAMIR KASSICIEH 2011-08-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2014-01-01	SAMIR KASSICIEH		SAMIR KASSICIEH	2015-10-15
001	2013-01-01	SAMIR KASSICIEH		SAMIR KASSICIEH	2014-09-09
001	2012-01-01	SAMIR KASSICIEH		SAMIR KASSICIEH	2013-06-30
001	2011-01-01	SAMIR KASSICIEH		SAMIR KASSICIEH	2012-10-11
001	2010-01-01	SAMIR KASSICIEH	2011-08-09	SAMIR KASSICIEH	2011-08-09

Plan Statistics for SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN

401k plan membership statisitcs for SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN

Measure Date Value
2014: SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 4
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 5
Number of participants with account balances 2014-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 5
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 3
Total of all active and inactive participants 2013-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 8
Number of participants with account balances 2013-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 5
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 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 7
Number of participants with account balances 2012-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
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 1
Total of all active and inactive participants 2011-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 5
Number of participants with account balances 2011-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2014: SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	4
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	5
Number of participants with account balances	2014-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	5
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	3
Total of all active and inactive participants	2013-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	8
Number of participants with account balances	2013-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	5
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	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	7
Number of participants with account balances	2012-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
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	1
Total of all active and inactive participants	2011-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	5
Number of participants with account balances	2011-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN

Measure	Date	Value
2014 : SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$70,699
Expenses. Total of all expenses incurred	2014-12-31	$46,214
Benefits paid (including direct rollovers)	2014-12-31	$42,961
Total plan assets at end of year	2014-12-31	$436,148
Total plan assets at beginning of year	2014-12-31	$411,663
Value of fidelity bond covering the plan	2014-12-31	$500,000
Assets. Value of tangible personal property	2014-12-31	$107,000
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$10,033
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$24,485
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$436,148
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$411,663
Total contributions received or receivable from employer(s)	2014-12-31	$60,666
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$3,253
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$72,664
Expenses. Total of all expenses incurred	2013-12-31	$45,085
Benefits paid (including direct rollovers)	2013-12-31	$45,085
Total plan assets at end of year	2013-12-31	$411,663
Total plan assets at beginning of year	2013-12-31	$384,084
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$36,437
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$27,579
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$411,663
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$384,084
Assets. Value of real-estate (other than employer real property)	2013-12-31	$107,000
Total contributions received or receivable from employer(s)	2013-12-31	$36,227
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 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	$71,092
Expenses. Total of all expenses incurred	2012-12-31	$11,333
Benefits paid (including direct rollovers)	2012-12-31	$11,333
Total plan assets at end of year	2012-12-31	$384,084
Total plan assets at beginning of year	2012-12-31	$324,325
Value of fidelity bond covering the plan	2012-12-31	$500,000
Total contributions received or receivable from participants	2012-12-31	$0
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	$29,744
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$59,759
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$384,084
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$324,325
Assets. Value of real-estate (other than employer real property)	2012-12-31	$107,000
Total contributions received or receivable from employer(s)	2012-12-31	$41,348
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	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$37,918
Expenses. Total of all expenses incurred	2011-12-31	$9,798
Benefits paid (including direct rollovers)	2011-12-31	$9,798
Total plan assets at end of year	2011-12-31	$324,325
Total plan assets at beginning of year	2011-12-31	$296,205
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-5,218
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$28,120
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$324,325
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$296,205
Assets. Value of real-estate (other than employer real property)	2011-12-31	$107,000
Total contributions received or receivable from employer(s)	2011-12-31	$43,136
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$-97,798
Expenses. Total of all expenses incurred	2010-12-31	$0
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$296,205
Total plan assets at beginning of year	2010-12-31	$394,003
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$-151,198
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$-97,798
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$296,205
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$394,003
Assets. Value of real-estate (other than employer real property)	2010-12-31	$107,000
Total contributions received or receivable from employer(s)	2010-12-31	$53,400
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0

Form 5500 Responses for SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN

2014: SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: SAMIR KASSICIEH, DO, PC PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
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: SAMIR KASSICIEH, DO, PC 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
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: SAMIR KASSICIEH, DO, PC 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
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

70372816

Policy instance

Insurance contract or identification number	70372816
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes

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Company Name:	KASMIR KASSICHIEH, DO, PC
Employer identification number (EIN):	742836796
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)