401k Plan data: NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING plan

NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING 401k Plan overview

Plan Name	NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING
Plan identification number	001

NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
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.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan covering Self-Employed individuals.
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

NORTH SHORE AMBULANCE, INC. has sponsored the creation of one or more 401k plans.

Company Name: NORTH SHORE AMBULANCE, INC.

Employer identification number (EIN): 042781114

NAIC Classification: 621900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2010-01-01 JOSEPH BUTLER
001 2009-01-01 ROBERT A DIONNE
001 2009-01-01 JOSEPH BUTLER
001 2009-01-01 ROBERT A DIONNE

Plan id#	Filing Submission Date	Name of Administrator
001	2010-01-01	JOSEPH BUTLER
001	2009-01-01	ROBERT A DIONNE
001	2009-01-01	JOSEPH BUTLER
001	2009-01-01	ROBERT A DIONNE

Plan Statistics for NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING

401k plan membership statisitcs for NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING

Measure Date Value
2010: NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING 2010 401k membership
Total participants, beginning-of-year 2010-01-01 94
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 71
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 19
Total of all active and inactive participants 2010-01-01 90
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 90
Number of participants with account balances 2010-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING 2009 401k membership
Total participants, beginning-of-year 2009-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 73
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 21
Total of all active and inactive participants 2009-01-01 94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 94
Number of participants with account balances 2009-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2010: NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING 2010 401k membership
Total participants, beginning-of-year	2010-01-01	94
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	71
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	19
Total of all active and inactive participants	2010-01-01	90
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	90
Number of participants with account balances	2010-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING 2009 401k membership
Total participants, beginning-of-year	2009-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	73
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	21
Total of all active and inactive participants	2009-01-01	94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	94
Number of participants with account balances	2009-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING

Measure	Date	Value
2011 : NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING 2011 401k financial data
Total income from all sources	2011-07-11	$3,704
Expenses. Total of all expenses incurred	2011-07-11	$189,997
Benefits paid (including direct rollovers)	2011-07-11	$165,410
Total plan assets at end of year	2011-07-11	$0
Total plan assets at beginning of year	2011-07-11	$186,293
Other income received	2011-07-11	$3,657
Net income (gross income less expenses)	2011-07-11	$-186,293
Net plan assets at end of year (total assets less liabilities)	2011-07-11	$0
Net plan assets at beginning of year (total assets less liabilities)	2011-07-11	$186,293
Total contributions received or receivable from employer(s)	2011-07-11	$47
Expenses. Administrative service providers (salaries,fees and commissions)	2011-07-11	$24,587
2010 : NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING 2010 401k financial data
Total income from all sources	2010-12-31	$14,334
Expenses. Total of all expenses incurred	2010-12-31	$64,690
Benefits paid (including direct rollovers)	2010-12-31	$64,590
Total plan assets at end of year	2010-12-31	$186,293
Total plan assets at beginning of year	2010-12-31	$236,649
Other income received	2010-12-31	$14,334
Net income (gross income less expenses)	2010-12-31	$-50,356
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$186,293
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$236,649
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$100
2009 : NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0
2008 : NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING 2008 401k financial data
Total unrealized appreciation/depreciation of assets	2008-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2008-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2008-12-31	$0
Total income from all sources (including contributions)	2008-12-31	$-129,144
Total loss/gain on sale of assets	2008-12-31	$0
Total of all expenses incurred	2008-12-31	$116,520
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2008-12-31	$100,983
Expenses. Certain deemed distributions of participant loans	2008-12-31	$119
Value of total corrective distributions	2008-12-31	$9,379
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2008-12-31	$60,885
Value of total assets at end of year	2008-12-31	$546,274
Value of total assets at beginning of year	2008-12-31	$791,938
Total of administrative expenses incurred including professional, contract, advisory and management fees	2008-12-31	$6,039
Total interest from all sources	2008-12-31	$3,301
Total dividends received (eg from common stock, registered investment company shares)	2008-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2008-12-31	No
Was this plan covered by a fidelity bond	2008-12-31	Yes
Value of fidelity bond cover	2008-12-31	$500,000
If this is an individual account plan, was there a blackout period	2008-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2008-12-31	No
Contributions received from participants	2008-12-31	$60,754
Participant contributions at end of year	2008-12-31	$33,999
Participant contributions at beginning of year	2008-12-31	$25,189
Participant contributions at beginning of year	2008-12-31	$5,376
Income. Received or receivable in cash from other sources (including rollovers)	2008-12-31	$131
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2008-12-31	No
Value of net income/loss	2008-12-31	$-245,664
Value of net assets at end of year (total assets less liabilities)	2008-12-31	$546,274
Value of net assets at beginning of year (total assets less liabilities)	2008-12-31	$791,938
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2008-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2008-12-31	No
Were any leases to which the plan was party in default or uncollectible	2008-12-31	No
Investment advisory and management fees	2008-12-31	$6,039
Value of interest in registered invesment companies (eg mutual funds) at end of year	2008-12-31	$512,275
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2008-12-31	$761,373
Interest on participant loans	2008-12-31	$3,301
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2008-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2008-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2008-12-31	$-193,330
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2008-12-31	No
Was there a failure to transmit to the plan any participant contributions	2008-12-31	No
Has the plan failed to provide any benefit when due under the plan	2008-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2008-12-31	$100,983
Did the plan have assets held for investment	2008-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2008-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2008-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2008-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2008-12-31	Disclaimer
Accountancy firm name	2008-12-31	DAN CLASBY & COMPANY
Accountancy firm EIN	2008-12-31	043395132

Form 5500 Responses for NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING

2010: NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: NORTH SHORE AMBULANCE, INC. 401(K) PROFIT SHARING 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

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Company Name:	NORTH SHORE AMBULANCE, INC.
Employer identification number (EIN):	042781114
NAIC Classification:	621900