Jack F. Jacoub, M.D., Inc.

Form 5500

JACK F. JACOUB, M.D., INC.

18111 Brookhurst Suite 6100, Fountain Valley, Ca 92708 (714) 378-7330 EIN:26-2878401 Plan Admin:Jjacoub

Year	Plan Name	Participants BOY/EOY	Assets BOY/EOY
2021	Plan NameJACK F. JACOUB, M. D. , INC. 401(K) PROFIT SHARING PLAN Plan #001 Participants BOY/EOY50 / 0 Assets BOY/EOY$1,215,435 / $0	2021	JACK F. JACOUB, M. D. , INC. 401(K) PROFIT SHARING PLAN - Plan #001	50 / 0	$1,215,435 / $0
2020	Plan NameJACK F. JACOUB, M.D., INC. 401(K) PROFIT SHARING PLAN Plan #001 Participants BOY/EOY48 / 49 Assets BOY/EOY$1,105,067 / $1,215,435	2020	JACK F. JACOUB, M.D., INC. 401(K) PROFIT SHARING PLAN - Plan #001	48 / 49	$1,105,067 / $1,215,435
2020	Plan NameJACK F. JACOUB, M.D., INC. DEFINED BENEFIT PENSION PLAN Plan #002 Participants BOY/EOY23 / 0 Assets BOY/EOY$1,278,246 / $0	2020	JACK F. JACOUB, M.D., INC. DEFINED BENEFIT PENSION PLAN - Plan #002	23 / 0	$1,278,246 / $0
2019	Plan NameJACK F. JACOUB, M.D., INC. DEFINED BENEFIT PENSION PLAN Plan #002 Participants BOY/EOY21 / 19 Assets BOY/EOY$938,011 / $1,278,246	2019	JACK F. JACOUB, M.D., INC. DEFINED BENEFIT PENSION PLAN - Plan #002	21 / 19	$938,011 / $1,278,246
2019	Plan NameJACK F. JACOUB, M.D., INC. 401(K) PROFIT SHARING PLAN Plan #001 Participants BOY/EOY40 / 42 Assets BOY/EOY$849,043 / $1,105,067	2019	JACK F. JACOUB, M.D., INC. 401(K) PROFIT SHARING PLAN - Plan #001	40 / 42	$849,043 / $1,105,067