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Plan Information

  • Plan Year01/01/2019 — 12/31/2019
  • Date of Plan01/01/2008
  • Net Assets as of 12/31/2019 $41,707,903
  • 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 Arrangement Trust

Participant Information as of 12/31/2019

  • Active (Eligible) Participants168
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits39
  • Subtotal207
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total207
  • Total number of participants as of 01/01/2019206
  • Number of participants with account balances207
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested0


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

Sponsor Information

  • Address185 Sotoyome
  • CitySanta Rosa
  • StateCA
  • Zip95405-4801
  • Telephone(707) 544-6090
  • EIN30-0500119
  • Industry Code621111

Plan Administrator Information

  • Administrator NameAnnadel Medical Group
  • Address500 Doyle Park Drive Ste 100
  • CitySanta Rosa
  • StateCA
  • Zip95405-4801
  • Telephone(707) 544-6090
  • Administrator EIN30-0500119

Audit Information

  • Audit StatusAudited
  • AuditorLance, Soll & Lunghard, LLP
  • Auditor EIN95-2700123
  • 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.

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? Yes $285,830
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 $500,000
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? No
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? No


Income and Expense Statement

Income $18,315,379
Contributions $12,072,740
Cash Contributions $12,072,740
Cash from Employers $4,322,082
Cash from Participants $2,414,338
Others (including rollovers) $5,336,320
Noncash Contributions $0
Total Earnings on Investments $6,215,619
Total Interest $9,687
Interest-Bearing Cash $230
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $9,457
Interest from Other Investments $0
Total Dividends $1,489,463
Preferred Stock $0
Common Stock $1,260
Rents $0
Net gain (loss) on sale of assets $4,220
Aggregate Proceeds $177,529
Aggregate Carrying Amount $173,309
Total Unrealized Appreciation (depreciation) of assets $65,670
Real Estate $0
Other $65,670
Net investment gain (loss) from common/collective trusts $0
Net investment gain (loss) from pooled separate accounts $0
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 $4,646,579
Other Income $27,020
Expenses $3,554,087
Total Benefit Payments $3,434,741
Directly to participants or beneficiaries, including direct rollovers $3,434,741
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 $119,346
Professional Fees $97,679
Contract Administrator Fees $0
Investment Advisory and management fees $21,667
Other Administrative Fees $0
Net Income $14,761,292
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2019 12/31/2018 Change YOY
Total Assets $41,707,903 $26,946,611 54.78%
Total noninterest-bearing cash $1,643,104 $0 0.0%
Receivables $135,523 $226,059 -40.05%
Employer Contributions $69,254 $141,161 -50.94%
Participant Contributions $66,269 $84,898 -21.94%
Other Contributions $0 $0 0.0%
General Investments $71,780 $0 0.0%
Interest-bearing cash $71,780 $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 $141,273 $0 0.0%
Preferred $0 $0 0.0%
Common $141,273 $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 $129,533 $111,148 16.54%
Value of interest in common/collective trusts $715,906 $363,406 97.00%
Value of interest in pooled separate accounts $0 $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 $38,870,784 $26,245,998 48.10%
Value of funds held in insurance co. general account $0 $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 $41,707,903 $26,946,611 54.78%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • Great-West Life & Annuity Ins. Co.
  • Charles Schwab & Co., Inc.

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
Great-West Life & Annuity Ins. Co. Recordkeeping fees Recordkeeper $37,095 $0 $37,095
Sageview Advisory Group, LLC Investment advisory (plan) Investment Advisor $22,252 $0 $22,252
Lance, Soll & Lunghard, LLP Accounting (including auditing) Auditor $18,845 $0 $18,845
Kravitz, LLC Consulting (pension), Recordkeeping fees NONE $9,674 $0 $9,674
Charles Schwab & Co., Inc. Recordkeeping fees, Shareholder servicing fees, Float revenue, Investment management, Securities brokerage, Direct payment from the plan, Investment management fees paid directly by plan, Investment management fees paid indirectly by plan, Securities brokerage commissions and fees Recordkeeper $12 $0 $12
Total $87,878 $0 $87,878

Indirect Compensation

There are no service providers with indirect compensation listed for this plan.

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.



Name of Investment Investment Manager Type of Investment Dollar Value
Putnam Stable Value Fund Putnam Investments DFE: Common/Collective Trust $715,906
Total $715,906

Insurance Information

Insurance Information

There are no insurance carriers listed for this plan.