401k Plan data: CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL plan

CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 401k Plan overview

Plan Name	CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL
Plan identification number	001

CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 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

CLERMONT PEDIATRICS, P.A. has sponsored the creation of one or more 401k plans.

Company Name: CLERMONT PEDIATRICS, P.A.

Employer identification number (EIN): 743243079

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

Additional information about CLERMONT PEDIATRICS, P.A.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2007-11-19

Company Identification Number: P07000124870

Legal Registered Office Address: 861 OAKLEY SEAVER DR

CLERMONT

34711

More information about CLERMONT PEDIATRICS, P.A.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 MONA PATEL
001 2016-01-01 MONA PATEL
001 2015-01-01 MONA PATEL
001 2015-01-01 MONA PATEL
001 2014-01-01 MONA PATEL 2015-07-14
001 2013-01-01 MONA PATEL 2014-10-14 MONA PATEL 2014-10-14

Plan Statistics for CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL

401k plan membership statisitcs for CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL

Measure Date Value
2017: CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2017 401k membership
Total participants, beginning-of-year 2017-01-01 16
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 17
Number of other retired or separated participants entitled to future benefits 2017-01-01 2
Total of all active and inactive participants 2017-01-01 19
Total participants 2017-01-01 19
Number of participants with account balances 2017-01-01 17
2016: CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2016 401k membership
Total participants, beginning-of-year 2016-01-01 16
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 16
Total of all active and inactive participants 2016-01-01 16
Total participants 2016-01-01 16
Number of participants with account balances 2016-01-01 11
2015: CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2015 401k membership
Total participants, beginning-of-year 2015-01-01 16
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 15
Number of other retired or separated participants entitled to future benefits 2015-01-01 3
Total of all active and inactive participants 2015-01-01 18
Total participants 2015-01-01 18
Number of participants with account balances 2015-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 2

Measure	Date	Value
2017: CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2017 401k membership
Total participants, beginning-of-year	2017-01-01	16
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	17
Number of other retired or separated participants entitled to future benefits	2017-01-01	2
Total of all active and inactive participants	2017-01-01	19
Total participants	2017-01-01	19
Number of participants with account balances	2017-01-01	17
2016: CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2016 401k membership
Total participants, beginning-of-year	2016-01-01	16
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	16
Total of all active and inactive participants	2016-01-01	16
Total participants	2016-01-01	16
Number of participants with account balances	2016-01-01	11
2015: CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2015 401k membership
Total participants, beginning-of-year	2015-01-01	16
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	15
Number of other retired or separated participants entitled to future benefits	2015-01-01	3
Total of all active and inactive participants	2015-01-01	18
Total participants	2015-01-01	18
Number of participants with account balances	2015-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	2

Financial Data on CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL

Measure	Date	Value
2017 : CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2017 401k financial data
Total income from all sources	2017-12-31	$290,713
Expenses. Total of all expenses incurred	2017-12-31	$4,500
Benefits paid (including direct rollovers)	2017-12-31	$4,500
Total plan assets at end of year	2017-12-31	$1,223,445
Total plan assets at beginning of year	2017-12-31	$937,232
Value of fidelity bond covering the plan	2017-12-31	$90,000
Total contributions received or receivable from participants	2017-12-31	$82,944
Other income received	2017-12-31	$164,934
Net income (gross income less expenses)	2017-12-31	$286,213
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$1,223,445
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$937,232
Total contributions received or receivable from employer(s)	2017-12-31	$42,835
2016 : CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2016 401k financial data
Total income from all sources	2016-12-31	$154,628
Expenses. Total of all expenses incurred	2016-12-31	$15,220
Benefits paid (including direct rollovers)	2016-12-31	$15,220
Total plan assets at end of year	2016-12-31	$937,232
Total plan assets at beginning of year	2016-12-31	$797,824
Value of fidelity bond covering the plan	2016-12-31	$90,000
Total contributions received or receivable from participants	2016-12-31	$69,804
Other income received	2016-12-31	$50,649
Net income (gross income less expenses)	2016-12-31	$139,408
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$937,232
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$797,824
Total contributions received or receivable from employer(s)	2016-12-31	$34,175
2015 : CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2015 401k financial data
Total income from all sources	2015-12-31	$70,836
Expenses. Total of all expenses incurred	2015-12-31	$12,641
Benefits paid (including direct rollovers)	2015-12-31	$12,641
Total plan assets at end of year	2015-12-31	$806,068
Total plan assets at beginning of year	2015-12-31	$747,873
Value of fidelity bond covering the plan	2015-12-31	$90,000
Total contributions received or receivable from participants	2015-12-31	$90,962
Other income received	2015-12-31	$-61,004
Net income (gross income less expenses)	2015-12-31	$58,195
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$806,068
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$747,873
Assets. Value of participant loans	2015-12-31	$407
Total contributions received or receivable from employer(s)	2015-12-31	$40,878

Form 5500 Responses for CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL

2017: CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CLERMONT PEDIATRICS, P.A. 401(K) PROFIT SHARING PL 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

SAVE-20888

Policy instance

Insurance contract or identification number	SAVE-20888
Number of Individuals Covered	19
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,313
Total amount of fees paid to insurance company	USD $550
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,313
Insurance broker organization code?	3
Amount paid for insurance broker fees	550
Additional information about fees paid to insurance broker	TPA ADMINISTRATION
Insurance broker name	BENEFITS OUTSOURCE, INC.

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )

Policy contract number

631619

Policy instance

Insurance contract or identification number	631619
Number of Individuals Covered	13
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,906
Total amount of fees paid to insurance company	USD $832
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	CLERMONT PEDIATRICS, P.A.
Employer identification number (EIN):	743243079
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2007-11-19
Company Identification Number:	P07000124870
Legal Registered Office Address:	861 OAKLEY SEAVER DR CLERMONT 34711

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	MONA PATEL
001	2016-01-01	MONA PATEL
001	2015-01-01	MONA PATEL
001	2015-01-01	MONA PATEL
001	2014-01-01	MONA PATEL	2015-07-14
001	2013-01-01	MONA PATEL	2014-10-14	MONA PATEL	2014-10-14