401k Plan data: JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN plan

JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 401k Plan overview

Plan Name	JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN
Plan identification number	002

JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Cash balance or similar plan - Plan has a "cash balance" formula. For this purpose, a "cash balance" formula is a benefit formula in a defined benefit plan by whatever name (for example, personal account plan, pension equity plan, life cycle plan, cash account plan, etc.) that rather than, or in addition to, expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee in terms more common to a defined contribution plan such as a single sum distribution amount (for example, 10 percent of final average pay times years of service, or the amount of the employee's hypothetical account balance).
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

JERZY GRZEBIELUCH, MD, LLC has sponsored the creation of one or more 401k plans.

Company Name: JERZY GRZEBIELUCH, MD, LLC

Employer identification number (EIN): 842608554

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

Additional information about JERZY GRZEBIELUCH, MD, LLC

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2019-07-10

Company Identification Number: L19000177507

Legal Registered Office Address: 4 2ND STREET, SE

FORT WALTON BEACH

32548

More information about JERZY GRZEBIELUCH, MD, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2023-01-01 JERZY GRZEBIELUCH 2024-07-09
002 2022-01-01 JERZY GRZEBIELUCH 2023-07-24
002 2021-01-01 JERZY GRZEBIELUCH 2022-03-16
002 2020-01-01 JERZY GRZEBIELUCH 2021-01-18
002 2019-01-01 JERZY GRZEBIELUCH 2020-09-21

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2023-01-01	JERZY GRZEBIELUCH	2024-07-09
002	2022-01-01	JERZY GRZEBIELUCH	2023-07-24
002	2021-01-01	JERZY GRZEBIELUCH	2022-03-16
002	2020-01-01	JERZY GRZEBIELUCH	2021-01-18
002	2019-01-01	JERZY GRZEBIELUCH	2020-09-21

Plan Statistics for JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN

401k plan membership statisitcs for JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN

Measure Date Value
2022: JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2022 401k membership
Market value of plan assets 2022-12-31 819,277
Acturial value of plan assets 2022-12-31 819,277
Funding target for retired participants and beneficiaries receiving payment 2022-12-31 0
Number of terminated vested participants 2022-12-31 0
Fundng target for terminated vested participants 2022-12-31 0
Active participant vested funding target 2022-12-31 555,751
Number of active participants 2022-12-31 3
Total funding liabilities for active participants 2022-12-31 555,751
Total participant count 2022-12-31 3
Total funding target for all participants 2022-12-31 555,751
Balance at beginning of prior year after applicable adjustments 2022-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2022-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2022-12-31 0
Prefunding balanced used to offset prior years funding requirement 2022-12-31 0
Amount remaining of carryover balance 2022-12-31 0
Amount remaining of prefunding balance 2022-12-31 0
Present value of excess contributions 2022-12-31 184,658
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2022-12-31 184,658
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2022-12-31 0
Reductions in caryover balances due to elections or deemed elections 2022-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2022-12-31 0
Balance of carryovers at beginning of current year 2022-12-31 0
Balance of prefunding at beginning of current year 2022-12-31 0
Total employer contributions 2022-12-31 250,000
Total employee contributions 2022-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2022-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2022-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2022-12-31 251,574
Unpaid minimum required contributions for all prior years 2022-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2022-12-31 0
Remaining amount of unpaid minimum required contributions 2022-12-31 0
Minimum required contributions for current year target normal cost 2022-12-31 183,029
Net shortfall amortization installment of oustanding balance 2022-12-31 0
Waiver amortization installment 2022-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2022-12-31 0
Carryover balance elected to use to offset funding requirement 2022-12-31 0
Prefunding balance elected to use to offset funding requirement 2022-12-31 0
Additional cash requirement 2022-12-31 0
Contributions allocatedtoward minimum required contributions for current year 2022-12-31 251,574
Unpaid minimum required contributions for current year 2022-12-31 0
Unpaid minimum required contributions for all years 2022-12-31 0
2021: JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2021 401k membership
Market value of plan assets 2021-12-31 535,378
Acturial value of plan assets 2021-12-31 535,378
Funding target for retired participants and beneficiaries receiving payment 2021-12-31 0
Number of terminated vested participants 2021-12-31 0
Fundng target for terminated vested participants 2021-12-31 0
Active participant vested funding target 2021-12-31 365,771
Number of active participants 2021-12-31 3
Total funding liabilities for active participants 2021-12-31 365,771
Total participant count 2021-12-31 3
Total funding target for all participants 2021-12-31 365,771
Balance at beginning of prior year after applicable adjustments 2021-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2021-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2021-12-31 0
Prefunding balanced used to offset prior years funding requirement 2021-12-31 0
Amount remaining of carryover balance 2021-12-31 0
Amount remaining of prefunding balance 2021-12-31 0
Present value of excess contributions 2021-12-31 92,356
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2021-12-31 92,356
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2021-12-31 0
Reductions in caryover balances due to elections or deemed elections 2021-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2021-12-31 0
Balance of carryovers at beginning of current year 2021-12-31 0
Balance of prefunding at beginning of current year 2021-12-31 0
Total employer contributions 2021-12-31 190,566
Total employee contributions 2021-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2021-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2021-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2021-12-31 192,172
Unpaid minimum required contributions for all prior years 2021-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2021-12-31 0
Remaining amount of unpaid minimum required contributions 2021-12-31 0
Minimum required contributions for current year target normal cost 2021-12-31 177,121
Net shortfall amortization installment of oustanding balance 2021-12-31 0
Waiver amortization installment 2021-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2021-12-31 7,514
Carryover balance elected to use to offset funding requirement 2021-12-31 0
Prefunding balance elected to use to offset funding requirement 2021-12-31 0
Additional cash requirement 2021-12-31 7,514
Contributions allocatedtoward minimum required contributions for current year 2021-12-31 192,172
Unpaid minimum required contributions for current year 2021-12-31 0
Unpaid minimum required contributions for all years 2021-12-31 0
2020: JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2020 401k membership
Market value of plan assets 2020-12-31 248,841
Acturial value of plan assets 2020-12-31 248,841
Funding target for retired participants and beneficiaries receiving payment 2020-12-31 0
Number of terminated vested participants 2020-12-31 0
Fundng target for terminated vested participants 2020-12-31 0
Active participant vested funding target 2020-12-31 170,291
Number of active participants 2020-12-31 3
Total funding liabilities for active participants 2020-12-31 170,291
Total participant count 2020-12-31 3
Total funding target for all participants 2020-12-31 170,291
Balance at beginning of prior year after applicable adjustments 2020-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2020-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2020-12-31 0
Prefunding balanced used to offset prior years funding requirement 2020-12-31 0
Amount remaining of carryover balance 2020-12-31 0
Amount remaining of prefunding balance 2020-12-31 0
Present value of excess contributions 2020-12-31 19,003
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2020-12-31 19,003
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2020-12-31 0
Reductions in caryover balances due to elections or deemed elections 2020-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2020-12-31 0
Balance of carryovers at beginning of current year 2020-12-31 0
Balance of prefunding at beginning of current year 2020-12-31 0
Total employer contributions 2020-12-31 180,000
Total employee contributions 2020-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2020-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2020-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2020-12-31 181,112
Unpaid minimum required contributions for all prior years 2020-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2020-12-31 0
Remaining amount of unpaid minimum required contributions 2020-12-31 0
Minimum required contributions for current year target normal cost 2020-12-31 167,306
Net shortfall amortization installment of oustanding balance 2020-12-31 0
Waiver amortization installment 2020-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2020-12-31 88,756
Carryover balance elected to use to offset funding requirement 2020-12-31 0
Prefunding balance elected to use to offset funding requirement 2020-12-31 0
Additional cash requirement 2020-12-31 88,756
Contributions allocatedtoward minimum required contributions for current year 2020-12-31 181,112
Unpaid minimum required contributions for current year 2020-12-31 0
Unpaid minimum required contributions for all years 2020-12-31 0
2019: JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2019 401k membership
Market value of plan assets 2019-12-31 0
Acturial value of plan assets 2019-12-31 0
Funding target for retired participants and beneficiaries receiving payment 2019-12-31 0
Number of terminated vested participants 2019-12-31 0
Fundng target for terminated vested participants 2019-12-31 0
Active participant vested funding target 2019-12-31 0
Number of active participants 2019-12-31 3
Total funding liabilities for active participants 2019-12-31 0
Total participant count 2019-12-31 3
Total funding target for all participants 2019-12-31 0
Balance at beginning of prior year after applicable adjustments 2019-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2019-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2019-12-31 0
Prefunding balanced used to offset prior years funding requirement 2019-12-31 0
Amount remaining of carryover balance 2019-12-31 0
Amount remaining of prefunding balance 2019-12-31 0
Present value of excess contributions 2019-12-31 0
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2019-12-31 0
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2019-12-31 0
Reductions in caryover balances due to elections or deemed elections 2019-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2019-12-31 0
Balance of carryovers at beginning of current year 2019-12-31 0
Balance of prefunding at beginning of current year 2019-12-31 0
Total employer contributions 2019-12-31 180,000
Total employee contributions 2019-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2019-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2019-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2019-12-31 179,047
Unpaid minimum required contributions for all prior years 2019-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2019-12-31 0
Remaining amount of unpaid minimum required contributions 2019-12-31 0
Minimum required contributions for current year target normal cost 2019-12-31 160,044
Net shortfall amortization installment of oustanding balance 2019-12-31 0
Waiver amortization installment 2019-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2019-12-31 160,044
Additional cash requirement 2019-12-31 160,044
Contributions allocatedtoward minimum required contributions for current year 2019-12-31 179,047
Unpaid minimum required contributions for current year 2019-12-31 0
Unpaid minimum required contributions for all years 2019-12-31 0

Measure	Date	Value
2022: JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2022 401k membership
Market value of plan assets	2022-12-31	819,277
Acturial value of plan assets	2022-12-31	819,277
Funding target for retired participants and beneficiaries receiving payment	2022-12-31	0
Number of terminated vested participants	2022-12-31	0
Fundng target for terminated vested participants	2022-12-31	0
Active participant vested funding target	2022-12-31	555,751
Number of active participants	2022-12-31	3
Total funding liabilities for active participants	2022-12-31	555,751
Total participant count	2022-12-31	3
Total funding target for all participants	2022-12-31	555,751
Balance at beginning of prior year after applicable adjustments	2022-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2022-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2022-12-31	0
Prefunding balanced used to offset prior years funding requirement	2022-12-31	0
Amount remaining of carryover balance	2022-12-31	0
Amount remaining of prefunding balance	2022-12-31	0
Present value of excess contributions	2022-12-31	184,658
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2022-12-31	184,658
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2022-12-31	0
Reductions in caryover balances due to elections or deemed elections	2022-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2022-12-31	0
Balance of carryovers at beginning of current year	2022-12-31	0
Balance of prefunding at beginning of current year	2022-12-31	0
Total employer contributions	2022-12-31	250,000
Total employee contributions	2022-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2022-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2022-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2022-12-31	251,574
Unpaid minimum required contributions for all prior years	2022-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2022-12-31	0
Remaining amount of unpaid minimum required contributions	2022-12-31	0
Minimum required contributions for current year target normal cost	2022-12-31	183,029
Net shortfall amortization installment of oustanding balance	2022-12-31	0
Waiver amortization installment	2022-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2022-12-31	0
Carryover balance elected to use to offset funding requirement	2022-12-31	0
Prefunding balance elected to use to offset funding requirement	2022-12-31	0
Additional cash requirement	2022-12-31	0
Contributions allocatedtoward minimum required contributions for current year	2022-12-31	251,574
Unpaid minimum required contributions for current year	2022-12-31	0
Unpaid minimum required contributions for all years	2022-12-31	0
2021: JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2021 401k membership
Market value of plan assets	2021-12-31	535,378
Acturial value of plan assets	2021-12-31	535,378
Funding target for retired participants and beneficiaries receiving payment	2021-12-31	0
Number of terminated vested participants	2021-12-31	0
Fundng target for terminated vested participants	2021-12-31	0
Active participant vested funding target	2021-12-31	365,771
Number of active participants	2021-12-31	3
Total funding liabilities for active participants	2021-12-31	365,771
Total participant count	2021-12-31	3
Total funding target for all participants	2021-12-31	365,771
Balance at beginning of prior year after applicable adjustments	2021-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2021-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2021-12-31	0
Prefunding balanced used to offset prior years funding requirement	2021-12-31	0
Amount remaining of carryover balance	2021-12-31	0
Amount remaining of prefunding balance	2021-12-31	0
Present value of excess contributions	2021-12-31	92,356
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2021-12-31	92,356
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2021-12-31	0
Reductions in caryover balances due to elections or deemed elections	2021-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2021-12-31	0
Balance of carryovers at beginning of current year	2021-12-31	0
Balance of prefunding at beginning of current year	2021-12-31	0
Total employer contributions	2021-12-31	190,566
Total employee contributions	2021-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2021-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2021-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2021-12-31	192,172
Unpaid minimum required contributions for all prior years	2021-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2021-12-31	0
Remaining amount of unpaid minimum required contributions	2021-12-31	0
Minimum required contributions for current year target normal cost	2021-12-31	177,121
Net shortfall amortization installment of oustanding balance	2021-12-31	0
Waiver amortization installment	2021-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2021-12-31	7,514
Carryover balance elected to use to offset funding requirement	2021-12-31	0
Prefunding balance elected to use to offset funding requirement	2021-12-31	0
Additional cash requirement	2021-12-31	7,514
Contributions allocatedtoward minimum required contributions for current year	2021-12-31	192,172
Unpaid minimum required contributions for current year	2021-12-31	0
Unpaid minimum required contributions for all years	2021-12-31	0
2020: JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2020 401k membership
Market value of plan assets	2020-12-31	248,841
Acturial value of plan assets	2020-12-31	248,841
Funding target for retired participants and beneficiaries receiving payment	2020-12-31	0
Number of terminated vested participants	2020-12-31	0
Fundng target for terminated vested participants	2020-12-31	0
Active participant vested funding target	2020-12-31	170,291
Number of active participants	2020-12-31	3
Total funding liabilities for active participants	2020-12-31	170,291
Total participant count	2020-12-31	3
Total funding target for all participants	2020-12-31	170,291
Balance at beginning of prior year after applicable adjustments	2020-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2020-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2020-12-31	0
Prefunding balanced used to offset prior years funding requirement	2020-12-31	0
Amount remaining of carryover balance	2020-12-31	0
Amount remaining of prefunding balance	2020-12-31	0
Present value of excess contributions	2020-12-31	19,003
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2020-12-31	19,003
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2020-12-31	0
Reductions in caryover balances due to elections or deemed elections	2020-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2020-12-31	0
Balance of carryovers at beginning of current year	2020-12-31	0
Balance of prefunding at beginning of current year	2020-12-31	0
Total employer contributions	2020-12-31	180,000
Total employee contributions	2020-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2020-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2020-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2020-12-31	181,112
Unpaid minimum required contributions for all prior years	2020-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2020-12-31	0
Remaining amount of unpaid minimum required contributions	2020-12-31	0
Minimum required contributions for current year target normal cost	2020-12-31	167,306
Net shortfall amortization installment of oustanding balance	2020-12-31	0
Waiver amortization installment	2020-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2020-12-31	88,756
Carryover balance elected to use to offset funding requirement	2020-12-31	0
Prefunding balance elected to use to offset funding requirement	2020-12-31	0
Additional cash requirement	2020-12-31	88,756
Contributions allocatedtoward minimum required contributions for current year	2020-12-31	181,112
Unpaid minimum required contributions for current year	2020-12-31	0
Unpaid minimum required contributions for all years	2020-12-31	0
2019: JERZY GRZEBIELUCH, MD, LLC CASH BALANCE PLAN 2019 401k membership
Market value of plan assets	2019-12-31	0
Acturial value of plan assets	2019-12-31	0
Funding target for retired participants and beneficiaries receiving payment	2019-12-31	0
Number of terminated vested participants	2019-12-31	0
Fundng target for terminated vested participants	2019-12-31	0
Active participant vested funding target	2019-12-31	0
Number of active participants	2019-12-31	3
Total funding liabilities for active participants	2019-12-31	0
Total participant count	2019-12-31	3
Total funding target for all participants	2019-12-31	0
Balance at beginning of prior year after applicable adjustments	2019-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2019-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2019-12-31	0
Prefunding balanced used to offset prior years funding requirement	2019-12-31	0
Amount remaining of carryover balance	2019-12-31	0
Amount remaining of prefunding balance	2019-12-31	0
Present value of excess contributions	2019-12-31	0
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2019-12-31	0
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2019-12-31	0
Reductions in caryover balances due to elections or deemed elections	2019-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2019-12-31	0
Balance of carryovers at beginning of current year	2019-12-31	0
Balance of prefunding at beginning of current year	2019-12-31	0
Total employer contributions	2019-12-31	180,000
Total employee contributions	2019-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2019-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2019-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2019-12-31	179,047
Unpaid minimum required contributions for all prior years	2019-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2019-12-31	0
Remaining amount of unpaid minimum required contributions	2019-12-31	0
Minimum required contributions for current year target normal cost	2019-12-31	160,044
Net shortfall amortization installment of oustanding balance	2019-12-31	0
Waiver amortization installment	2019-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2019-12-31	160,044
Additional cash requirement	2019-12-31	160,044
Contributions allocatedtoward minimum required contributions for current year	2019-12-31	179,047
Unpaid minimum required contributions for current year	2019-12-31	0
Unpaid minimum required contributions for all years	2019-12-31	0

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Company Name:	JERZY GRZEBIELUCH, MD, LLC
Employer identification number (EIN):	842608554
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2019-07-10
Company Identification Number:	L19000177507
Legal Registered Office Address:	4 2ND STREET, SE FORT WALTON BEACH 32548