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FORM 5500 DATA

Galen Medical Group, P.C. Employees' Retirement Savings Plan

Overview

Plan Information

  • Plan Year01/01/2016 — 12/31/2016
  • Date of Plan01/01/1995
  • Net Assets as of 12/31/2016 $27,582,385
  • Plan Number1
  • Plan Type Single Employer
  • Is the plan collectively bargained? No
  • Did the plan file for an extension of time or the DFVC Program?Yes
  • Plan Funding ArrangementInsurance Trust
  • Plan Benefit ArrangementInsurance Trust

Participant Information as of 12/31/2016

  • Active (Eligible) Participants350
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits30
  • Subtotal380
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits1
  • Total381
  • Total number of participants as of 01/01/2016401
  • Number of participants with account balances378
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested0

Expenses

  • Total Benefit Payments$0
  • Corrective Distributions$0
  • Administrative Service Providers$0
  • Other Expenses$0
  • Total Expenses$0
  • Total Transfers$0

Sponsor Information

  • Address4976 Alpha Ln
  • CityHixson
  • StateTN
  • Zip37343
  • Telephone(423) 308-0524
  • EIN62-1508884
  • Industry Code621111
  • Named AdministratorKatie Ashby
  • Named Plan SponsorKatie Ashby

Audit Information

  • Audit StatusAudited
  • AuditorNeal, Scouten & Mcconnell, Pc
  • Auditor EIN62-1646291
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

Benefits Provided Under the Plan

Code Benefit Description
2A Age/Service Weighted or New Comparability or Similar Plan Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New Comparability or Similar Plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the threshold or additional rate allowed under the permitted disparity rules of section 401(l)
2E Profit-sharing A defined contribution plan that allows employer discretionary contributions. These plans often contain a 401(k) feature.
2F ERISA section 404(c) Plan This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
2G 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.
2J 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.
2S Automatic Enrollment Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
2T Participant-directed Account Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

Questions and Answers

Question Answer Amount
During the plan year did the employer fail to transmit to the plan any participant contributions within the time period described in 29 CFT 2510.3-102? No
Were any loans by the plan or fixed income obligations due the plan in default as of the close of plan year or classified during the year as uncollectible? Disregard participant loans secured by participant's account balance. No
Were any leases to which the plan was a party in default or classified during the year as uncollectible? No
Were there any nonexempt transactions with any party-in-interest? No
Was this plan covered by a fidelity bond? Yes $1,000,000
Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud or dishonesty? No
Did the plan hold any assets whose current value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan receive any noncash contributions whose value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan have assets held for investment? Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? No
Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? No
Has the plan failed to provide any benefit when due under the plan? No
If this is an individual account plan, was there a blackout period? Yes
If there was a blackout period, have you either provided the required notice or one of the exceptions to providing the notice applied under 29 CFR 2520.101-3? Yes

Financials

Income and Expense Statement

Income $4,108,845
Contributions $3,109,715
Cash Contributions $3,109,715
Cash from Employers $1,235,765
Cash from Participants $1,346,831
Others (including rollovers) $527,119
Noncash Contributions $0
Total Earnings on Investments $999,130
Total Interest $2,368
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $0
Interest from Other Investments $2,368
Total Dividends $17,381
Preferred Stock $0
Common Stock $0
Rents $0
Net gain (loss) on sale of assets $0
Aggregate Proceeds $0
Aggregate Carrying Amount $0
Total Unrealized Appreciation (depreciation) of assets $0
Real Estate $0
Other $0
Net investment gain (loss) from common/collective trusts $2,012,199
Net investment gain (loss) from pooled separate accounts $235,049
Net investment gain (loss) from master trust investment accounts $0
Net investment gain (loss) from 103-12 investment entities $0
Net investment gain (loss) from registered investment companies $-1,267,867
Other Income $0
Expenses $1,005,076
Total Benefit Payments $944,738
Directly to participants or beneficiaries, including direct rollovers $944,738
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $0
Certain deemed distributions of participant loans $0
Interest expense $0
Total Administrative Expenses $60,338
Professional Fees $0
Contract Administrator Fees $60,338
Investment Advisory and management fees $0
Other Administrative Fees $0
Net Income $3,103,769
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2016 12/31/2015 Change YOY
Total Assets $27,582,385 $24,478,616 12.68%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $66,171 $0 0.0%
Employer Contributions $3,640 $0 0.0%
Participant Contributions $62,531 $0 0.0%
Other Contributions $0 $0 0.0%
General Investments $0 $0 0.0%
Interest-bearing cash $0 $0 0.0%
U.S. Government Securities $0 $0 0.0%
Corporate Debt Instruments $0 $0 0.0%
Preferred $0 $0 0.0%
All Other $0 $0 0.0%
Corporate Stocks $0 $0 0.0%
Preferred $0 $0 0.0%
Common $0 $0 0.0%
Partnership/joint venture interests $0 $0 0.0%
Real estate (other than employer real property) $0 $0 0.0%
Loans (other than to participants) $0 $0 0.0%
Participants Loans $0 $0 0.0%
Value of interest in common/collective trusts $24,055,815 $84,629 28325.03%
Value of interest in pooled separate accounts $2,457,873 $0 0.0%
Value of interest in master trust investment accounts $0 $0 0.0%
Value of interest in 103-12 investment entities $0 $0 0.0%
Value of interest in registered investment companies $815,871 $24,393,987 -96.66%
Value of funds held in insurance co. general account $186,655 $0 0.0%
Other Investments $0 $0 0.0%
Employer-related Investments $0 $0 0.0%
Employer Securities $0 $0 0.0%
Employer Real Property $0 $0 0.0%
Buildings and other property used in plan operation $0 $0 0.0%
Total Liabilities $0 $0 0.0%
Benefit Claims Payable (1) $0 $0 0.0%
Operating Payables (1) $0 $0 0.0%
Acquisition Indebtedness (1) $0 $0 0.0%
Other liabilities (1) $0 $0 0.0%
Net Assets $27,582,385 $24,478,616 12.68%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • Principal Life Insurance Company

Other Service Providers Receiving Direct or Indirect Compensation

Name Nature of Service Relationship to Plan Sponsor Direct Compensation Paid by Plan Indirect Compensation Paid by Plan Total Compensation
Principal Life Insurance Company Contract Administrator, Direct payment from the plan, Recordkeeping fees Contract Administrator $57,770 $0 $57,770
Bruner, Robert J. Other services, Other commissions Other Services $0 $13,213 $13,213
Wilshire Associates Incorporated Investment advisory (plan), Other investment fees and expenses Investment Advisory $0 $0 $0
Total $57,770 $13,213 $70,983

Indirect Compensation

Name Source of Indirect Compensation* Nature of Service Description of Indirect Compensation Indirect Compensation Paid by Plan
Bruner, Robert J. Principal Life Insurance Company Other services, Other commissions Commissions $13,213
Wilshire Associates Incorporated Galen Medical Group Employees Investment advisory (plan), Other investment fees and expenses 1 Basis Point Annually On Total Plan Assets In Wilshire's 3(21) Investment Fiduciary Service Per Client's Signed Agreement With Wilshire. $0
*As outlined by the Form 5500 Instructions for service providers with indirect compensation.

Service Providers Who Fail or Refuse to Provide Information

There are no service providers who failed or refused to provide information.

Termination Information on Accountants and Enrolled Actuaries

There is no termination information for this plan.

Investments

Investments

Name of Investment Investment Manager Type of Investment Dollar Value
Prin Trust(Sm) Tgt 2030 Fd Z Principal Trust Company DFE: Common/Collective Trust $4,864,390
Prin Trust(Sm) Tgt 2025 Fd Z Principal Trust Company DFE: Common/Collective Trust $4,753,957
Prin Trust(Sm) Tgt 2035 Fd Z Principal Trust Company DFE: Common/Collective Trust $3,596,836
Prin Trust(Sm) Tgt 2015 Fd Z Principal Trust Company DFE: Common/Collective Trust $3,120,839
Prin Trust(Sm) Tgt 2020 Fd Z Principal Trust Company DFE: Common/Collective Trust $2,835,745
Prin Trust(Sm) Tgt 2040 Fd Z Principal Trust Company DFE: Common/Collective Trust $2,049,174
Prin Trust Tgt 2010 Fd Z Principal Trust Company DFE: Common/Collective Trust $1,445,554
Prin Largecap Growth I Sa-Z Principal Life Insurance Company DFE: Pooled Separate Account $814,330
Prin Lgcp S&P 500 Index Sa-Z Principal Life Insurance Company DFE: Pooled Separate Account $439,398
Prin Trust(Sm) Tgt 2045 Fd Z Principal Trust Company DFE: Common/Collective Trust $399,545
Prin Income Sep Acct-Z Principal Life Insurance Company DFE: Pooled Separate Account $357,828
Prin Trust(Sm) Tgt 2050 Fd Z Principal Trust Company DFE: Common/Collective Trust $303,822
Prin Smcap S&P 600 Index Sa-Z Principal Life Insurance Company DFE: Pooled Separate Account $299,327
Prin Midcap S&P 400 Idx Sa-Z Principal Life Insurance Company DFE: Pooled Separate Account $287,765
Prin Trust(Sm) Tgt 2055 Fd Z Principal Trust Company DFE: Common/Collective Trust $240,101
Prin Trust(Sm) Income Fund Z Principal Trust Company DFE: Common/Collective Trust $229,885
Fidelity Mip I Fund Fidelity Management Trust Company DFE: Common/Collective Trust $208,658
Prin Gl Real Est Sec Sa-Z Principal Life Insurance Company DFE: Pooled Separate Account $99,407
Prin Real Estate Secs Sa-Z Principal Life Insurance Company DFE: Pooled Separate Account $58,598
Prin Midcap Growth Sep Acct-Z Principal Life Insurance Company DFE: Pooled Separate Account $41,915
Prin Diversified Intl Sa-Z Principal Life Insurance Company DFE: Pooled Separate Account $40,283
Prin Midcap Value III Sa-Z Principal Life Insurance Company DFE: Pooled Separate Account $14,160
Prin Trust Tgt 2060 Fd Z Principal Trust Company DFE: Common/Collective Trust $7,309
Prin Intl I Separate Acct-Z Principal Life Insurance Company DFE: Pooled Separate Account $4,863
Total $26,513,689

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Principal Life Insurance Company 381
EIN 42-0127290
Industry Code 61271
Contract Number 613953
Contract Year 03/01/2016 — 12/31/2016
Value in General Account at Year End $0
Value in Separate Accounts at Year End $0
Insurance Fees and Commissions $100
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Bruner, Robert J. 605 Chestnut St Ste 300 Chattanooga, TN 37450 -0006 Insurance Agent or Broker $100 $0
Allocated Funds
Type of Contract Unspecified
Basis of premium rates
Premiums paid to carrier $0
Premiums due but unpaid at the end of the year $0
If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount $0
Specify the nature of the costs
Unallocated Funds
Type of Contract CUSTODIAL GUARANTEED INTEREST CONTRACT
Balance at the end of the previous year $0
Additions $300,879
Contributions Deposited during the year $12,249
Dividends and credits $0
Interest credited during the year $2,368
Transferred from separate account $0
Other $286,262
Total of Balance and Additions $300,879
Deductions $114,224
Disbursed from fund to pay benefits or purchase annuities during the year $7,473
Administration charge made by carrier $357
Transferred to Separate Account $0
Other $106,394
Balance at the end of the current year $186,655
Principal Life Insurance Company 381
EIN 42-0127290
Industry Code 61271
Contract Number 717348
Contract Year 03/01/2016 — 12/31/2016
Value in General Account at Year End $0
Value in Separate Accounts at Year End $2,457,873
Insurance Fees and Commissions $1,324
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Bruner, Robert J. 605 Chestnut St Ste 300 Chattanooga, TN 37450 -0006 Insurance Agent or Broker $1,324 $0
Allocated Funds
Type of Contract Unspecified
Basis of premium rates
Premiums paid to carrier $0
Premiums due but unpaid at the end of the year $0
If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount $0
Specify the nature of the costs
Unallocated Funds
Type of Contract Unspecified
Balance at the end of the previous year $0
Additions $0
Contributions Deposited during the year $0
Dividends and credits $0
Interest credited during the year $0
Transferred from separate account $0
Other $0
Total of Balance and Additions $0
Deductions $0
Disbursed from fund to pay benefits or purchase annuities during the year $0
Administration charge made by carrier $0
Transferred to Separate Account $0
Other $0
Balance at the end of the current year $0