401k Plan data: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN plan

PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 401k Plan overview

Plan Name	PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN
Plan identification number	001

PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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 theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.
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

PARADISE VALLEY PINNACLE PEAK PERIODONTICS, PLLC has sponsored the creation of one or more 401k plans.

Company Name: PARADISE VALLEY PINNACLE PEAK PERIODONTICS, PLLC

Employer identification number (EIN): 201473037

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01 CHRISTINA BROSIUS 2022-10-07 CHRISTINA BROSIUS 2022-10-07
001 2020-01-01 STEVE REITAN 2021-10-14
001 2019-01-01
001 2018-01-01
001 2017-01-01
001 2016-01-01 STEVEN REITAN 2017-10-11
001 2015-01-01 STEVEN REITAN 2016-10-17
001 2014-01-01 STEVEN REITAN 2015-10-15
001 2013-01-01 STEVEN REITAN 2014-10-13
001 2012-01-01 STEVEN REITAN 2013-10-08
001 2011-01-01 STEVEN REITAN 2012-08-30
001 2009-01-01 STEVEN REITAN
001 2009-01-01 STEVEN G. REITAN, DDS
001 2009-01-01 STEVEN G. REITAN, DDS
001 2009-01-01 STEVEN G. REITAN, DDS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01	CHRISTINA BROSIUS	2022-10-07	CHRISTINA BROSIUS	2022-10-07
001	2020-01-01	STEVE REITAN	2021-10-14
001	2019-01-01
001	2018-01-01
001	2017-01-01
001	2016-01-01	STEVEN REITAN	2017-10-11
001	2015-01-01	STEVEN REITAN	2016-10-17
001	2014-01-01	STEVEN REITAN	2015-10-15
001	2013-01-01	STEVEN REITAN	2014-10-13
001	2012-01-01	STEVEN REITAN	2013-10-08
001	2011-01-01	STEVEN REITAN	2012-08-30
001	2009-01-01	STEVEN REITAN
001	2009-01-01	STEVEN G. REITAN, DDS
001	2009-01-01	STEVEN G. REITAN, DDS
001	2009-01-01	STEVEN G. REITAN, DDS

Plan Statistics for PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN

401k plan membership statisitcs for PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN

Measure Date Value
2022: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 140
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 90
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 57
Total of all active and inactive participants 2022-01-01 147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 147
Number of participants with account balances 2022-01-01 147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 6
2021: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 140
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 104
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 33
Total of all active and inactive participants 2021-01-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 137
Number of participants with account balances 2021-01-01 137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 98
Number of other retired or separated participants entitled to future benefits 2020-01-01 42
Total of all active and inactive participants 2020-01-01 140
Total participants 2020-01-01 140
Number of participants with account balances 2020-01-01 140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 1
2009: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 24
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 21
Number of other retired or separated participants entitled to future benefits 2009-01-01 4
Total of all active and inactive participants 2009-01-01 25
Total participants 2009-01-01 25
Number of participants with account balances 2009-01-01 25

Measure	Date	Value
2022: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	140
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	90
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	57
Total of all active and inactive participants	2022-01-01	147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	147
Number of participants with account balances	2022-01-01	147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	6
2021: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	140
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	104
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	33
Total of all active and inactive participants	2021-01-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	137
Number of participants with account balances	2021-01-01	137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	98
Number of other retired or separated participants entitled to future benefits	2020-01-01	42
Total of all active and inactive participants	2020-01-01	140
Total participants	2020-01-01	140
Number of participants with account balances	2020-01-01	140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	1
2009: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	24
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	21
Number of other retired or separated participants entitled to future benefits	2009-01-01	4
Total of all active and inactive participants	2009-01-01	25
Total participants	2009-01-01	25
Number of participants with account balances	2009-01-01	25

Financial Data on PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN

Measure	Date	Value
2022 : PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2022 401k financial data
Expenses. Interest paid	2022-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-218,723
Total of all expenses incurred	2022-12-31	$183,596
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$180,475
Expenses. Certain deemed distributions of participant loans	2022-12-31	$0
Value of total corrective distributions	2022-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$829,215
Value of total assets at end of year	2022-12-31	$7,534,881
Value of total assets at beginning of year	2022-12-31	$7,937,200
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$3,121
Total interest from all sources	2022-12-31	$4,273
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Administrative expenses professional fees incurred	2022-12-31	$0
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$450,839
Participant contributions at end of year	2022-12-31	$93,978
Participant contributions at beginning of year	2022-12-31	$83,097
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$7,869
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Income. Non cash contributions	2022-12-31	$0
Value of net income/loss	2022-12-31	$-402,319
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$7,534,881
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$7,937,200
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$3,121
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$5,838,926
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$6,248,399
Interest on participant loans	2022-12-31	$4,272
Value of interest in common/collective trusts at end of year	2022-12-31	$1,473,083
Value of interest in common/collective trusts at beginning of year	2022-12-31	$1,496,435
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$1
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,081,198
Net investment gain or loss from common/collective trusts	2022-12-31	$28,987
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$370,507
Employer contributions (assets) at end of year	2022-12-31	$128,894
Employer contributions (assets) at beginning of year	2022-12-31	$109,269
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$180,475
Contract administrator fees	2022-12-31	$0
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	BALDWIN MOFFITT BEHM LLP
Accountancy firm EIN	2022-12-31	464370753
2021 : PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2021 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$1,697,284
Total of all expenses incurred	2021-12-31	$275,846
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$270,585
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$751,682
Value of total assets at end of year	2021-12-31	$7,937,200
Value of total assets at beginning of year	2021-12-31	$6,515,762
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$5,261
Total interest from all sources	2021-12-31	$5,362
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$397,301
Participant contributions at end of year	2021-12-31	$83,097
Participant contributions at beginning of year	2021-12-31	$104,997
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$14,056
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$1,421,438
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$7,937,200
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$6,515,762
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$5,261
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$6,248,399
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$5,142,973
Interest on participant loans	2021-12-31	$5,362
Value of interest in common/collective trusts at end of year	2021-12-31	$1,496,435
Value of interest in common/collective trusts at beginning of year	2021-12-31	$1,186,733
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$340,325
Employer contributions (assets) at end of year	2021-12-31	$109,269
Employer contributions (assets) at beginning of year	2021-12-31	$81,059
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$270,585
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	BALDWIN MOFFITT BEHM LLP
Accountancy firm EIN	2021-12-31	464370753
2020 : PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2020 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$140
Total income from all sources (including contributions)	2020-12-31	$1,433,822
Total of all expenses incurred	2020-12-31	$401,122
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$397,733
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$718,988
Value of total assets at end of year	2020-12-31	$6,515,762
Value of total assets at beginning of year	2020-12-31	$5,483,202
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$3,389
Total interest from all sources	2020-12-31	$4,661
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$374,195
Participant contributions at end of year	2020-12-31	$104,997
Participant contributions at beginning of year	2020-12-31	$18,467
Participant contributions at beginning of year	2020-12-31	$4,592
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$10,966
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$140
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$1,032,700
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$6,515,762
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$5,483,062
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$3,389
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$5,142,973
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$4,216,645
Interest on participant loans	2020-12-31	$4,661
Value of interest in master investment trust accounts at beginning of year	2020-12-31	$1,194,715
Value of interest in common/collective trusts at end of year	2020-12-31	$1,186,733
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$333,827
Employer contributions (assets) at end of year	2020-12-31	$81,059
Employer contributions (assets) at beginning of year	2020-12-31	$48,783
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$397,733
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	BALDWIN MOFFITT BEHM LLP
Accountancy firm EIN	2020-12-31	464370753
2010 : PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$343,394
Expenses. Total of all expenses incurred	2010-12-31	$120,267
Benefits paid (including direct rollovers)	2010-12-31	$111,231
Total plan assets at end of year	2010-12-31	$1,144,132
Total plan assets at beginning of year	2010-12-31	$921,005
Value of fidelity bond covering the plan	2010-12-31	$120,000
Total contributions received or receivable from participants	2010-12-31	$146,339
Expenses. Other expenses not covered elsewhere	2010-12-31	$625
Other income received	2010-12-31	$146,587
Net income (gross income less expenses)	2010-12-31	$223,127
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,144,132
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$921,005
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2010-12-31	$565
Total contributions received or receivable from employer(s)	2010-12-31	$50,468
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$8,411

Form 5500 Responses for PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN

2022: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2009: PARADISE VALLEY PINNACLE PEAK PERIODONTICS 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

78603

Policy instance

Insurance contract or identification number	78603
Number of Individuals Covered	19
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,704
Total amount of fees paid to insurance company	USD $1,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,704
Insurance broker organization code?	4
Amount paid for insurance broker fees	1102
Additional information about fees paid to insurance broker	TPA FORUM COMPENSATION
Insurance broker name	BOYCE & ASSOCIATES, INC.

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Company Name:	PARADISE VALLEY PINNACLE PEAK PERIODONTICS, PLLC
Employer identification number (EIN):	201473037
NAIC Classification:	621210
NAIC Description:	Offices of Dentists