401k Plan data: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN plan

ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 401k Plan overview

Plan Name	ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN
Plan identification number	002

ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Profit-sharing 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.

401k Sponsoring company profile

ROLAND E. SIEGLER, M.D., P.A. has sponsored the creation of one or more 401k plans.

Company Name: ROLAND E. SIEGLER, M.D., P.A.

Employer identification number (EIN): 751737351

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2015-01-01 ROLAND SIEGLER ROLAND SIEGLER 2016-07-25
002 2014-01-01 ROLAND SIEGLER ROLAND SIEGLER 2015-07-31
002 2013-01-01 ROLAND E. SIEGLER
002 2012-01-01 ROLAND E. SIEGLER
002 2011-01-01 ROLAND E SIEGLER
002 2010-01-01 ROLAND E SIEGLER
002 2009-01-01 ROLAND E SIEGLER

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2015-01-01	ROLAND SIEGLER	ROLAND SIEGLER	2016-07-25
002	2014-01-01	ROLAND SIEGLER	ROLAND SIEGLER	2015-07-31
002	2013-01-01	ROLAND E. SIEGLER
002	2012-01-01	ROLAND E. SIEGLER
002	2011-01-01	ROLAND E SIEGLER
002	2010-01-01	ROLAND E SIEGLER
002	2009-01-01	ROLAND E SIEGLER

Plan Statistics for ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN

401k plan membership statisitcs for ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN

Measure Date Value
2015: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2
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 2
Total of all active and inactive participants 2014-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 4
Number of participants with account balances 2014-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: ROLAND E. SIEGLER, M.D., P.A. 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 2
Number of retired or separated participants receiving benefits 2013-01-01 1
Number of other retired or separated participants entitled to future benefits 2013-01-01 5
Total of all active and inactive participants 2013-01-01 8
Total participants 2013-01-01 8
Number of participants with account balances 2013-01-01 8
2012: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 5
Number of other retired or separated participants entitled to future benefits 2012-01-01 3
Total of all active and inactive participants 2012-01-01 8
Total participants 2012-01-01 8
Number of participants with account balances 2012-01-01 8
2011: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 7
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 8
Total participants 2011-01-01 8
Number of participants with account balances 2011-01-01 8
2010: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 7
Number of other retired or separated participants entitled to future benefits 2010-01-01 1
Total of all active and inactive participants 2010-01-01 8
Total participants 2010-01-01 8
Number of participants with account balances 2010-01-01 8
2009: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 7
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 1
Total of all active and inactive participants 2009-01-01 9
Total participants 2009-01-01 9
Number of participants with account balances 2009-01-01 9

Measure	Date	Value
2015: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2
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	2
Total of all active and inactive participants	2014-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	4
Number of participants with account balances	2014-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: ROLAND E. SIEGLER, M.D., P.A. 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	2
Number of retired or separated participants receiving benefits	2013-01-01	1
Number of other retired or separated participants entitled to future benefits	2013-01-01	5
Total of all active and inactive participants	2013-01-01	8
Total participants	2013-01-01	8
Number of participants with account balances	2013-01-01	8
2012: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	5
Number of other retired or separated participants entitled to future benefits	2012-01-01	3
Total of all active and inactive participants	2012-01-01	8
Total participants	2012-01-01	8
Number of participants with account balances	2012-01-01	8
2011: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	7
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	8
Total participants	2011-01-01	8
Number of participants with account balances	2011-01-01	8
2010: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	7
Number of other retired or separated participants entitled to future benefits	2010-01-01	1
Total of all active and inactive participants	2010-01-01	8
Total participants	2010-01-01	8
Number of participants with account balances	2010-01-01	8
2009: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	7
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	1
Total of all active and inactive participants	2009-01-01	9
Total participants	2009-01-01	9
Number of participants with account balances	2009-01-01	9

Financial Data on ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN

Measure	Date	Value
2015 : ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$-57,230
Expenses. Total of all expenses incurred	2015-12-31	$1,594,363
Benefits paid (including direct rollovers)	2015-12-31	$1,575,674
Total plan assets at end of year	2015-12-31	$0
Total plan assets at beginning of year	2015-12-31	$1,651,593
Other income received	2015-12-31	$-57,230
Net income (gross income less expenses)	2015-12-31	$-1,651,593
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,651,593
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$18,689
2014 : ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$82,796
Expenses. Total of all expenses incurred	2014-12-31	$402,687
Benefits paid (including direct rollovers)	2014-12-31	$385,291
Total plan assets at end of year	2014-12-31	$1,651,593
Total plan assets at beginning of year	2014-12-31	$1,971,484
Total contributions received or receivable from participants	2014-12-31	$23,000
Other income received	2014-12-31	$57,619
Net income (gross income less expenses)	2014-12-31	$-319,891
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,651,593
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,971,484
Total contributions received or receivable from employer(s)	2014-12-31	$2,177
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$17,396
2013 : ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$213,811
Expenses. Total of all expenses incurred	2013-12-31	$198,710
Benefits paid (including direct rollovers)	2013-12-31	$181,435
Total plan assets at end of year	2013-12-31	$1,971,484
Total plan assets at beginning of year	2013-12-31	$1,956,383
Total contributions received or receivable from participants	2013-12-31	$48,544
Expenses. Other expenses not covered elsewhere	2013-12-31	$17,275
Other income received	2013-12-31	$153,893
Net income (gross income less expenses)	2013-12-31	$15,101
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,971,484
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,956,383
Total contributions received or receivable from employer(s)	2013-12-31	$11,374
2012 : ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$239,205
Expenses. Total of all expenses incurred	2012-12-31	$10,564
Total plan assets at end of year	2012-12-31	$1,956,383
Total plan assets at beginning of year	2012-12-31	$1,727,742
Total contributions received or receivable from participants	2012-12-31	$54,464
Expenses. Other expenses not covered elsewhere	2012-12-31	$10,564
Other income received	2012-12-31	$167,800
Net income (gross income less expenses)	2012-12-31	$228,641
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,956,383
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,727,742
Total contributions received or receivable from employer(s)	2012-12-31	$16,941
2011 : ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$69,680
Expenses. Total of all expenses incurred	2011-12-31	$18,926
Total plan assets at end of year	2011-12-31	$1,727,742
Total plan assets at beginning of year	2011-12-31	$1,676,988
Value of fidelity bond covering the plan	2011-12-31	$70,000
Total contributions received or receivable from participants	2011-12-31	$57,464
Expenses. Other expenses not covered elsewhere	2011-12-31	$18,926
Other income received	2011-12-31	$4,533
Net income (gross income less expenses)	2011-12-31	$50,754
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,727,742
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,676,988
Assets. Value of participant loans	2011-12-31	$1,520
Total contributions received or receivable from employer(s)	2011-12-31	$7,683
2010 : ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$240,151
Expenses. Total of all expenses incurred	2010-12-31	$16,365
Total plan assets at end of year	2010-12-31	$1,676,988
Total plan assets at beginning of year	2010-12-31	$1,453,202
Value of fidelity bond covering the plan	2010-12-31	$70,000
Total contributions received or receivable from participants	2010-12-31	$57,464
Expenses. Other expenses not covered elsewhere	2010-12-31	$16,365
Other income received	2010-12-31	$163,223
Net income (gross income less expenses)	2010-12-31	$223,786
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,676,988
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,453,202
Assets. Value of participant loans	2010-12-31	$6,918
Total contributions received or receivable from employer(s)	2010-12-31	$19,464

Form 5500 Responses for ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN

2015: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	Yes
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: ROLAND E. SIEGLER, M.D., P.A. 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: ROLAND E. SIEGLER, M.D., P.A. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	ROLAND E. SIEGLER, M.D., P.A.
Employer identification number (EIN):	751737351
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)