401k Plan data: PAUL L. DIONNE, DMD RETIREMENT PLAN plan

PAUL L. DIONNE, DMD RETIREMENT PLAN 401k Plan overview

Plan Name	PAUL L. DIONNE, DMD RETIREMENT PLAN
Plan identification number	002

PAUL L. DIONNE, DMD RETIREMENT 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
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.
Plan covering Self-Employed individuals.

401k Sponsoring company profile

PAUL L. DIONNE, DMD has sponsored the creation of one or more 401k plans.

Company Name: PAUL L. DIONNE, DMD

Employer identification number (EIN): 223246865

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PAUL L. DIONNE, DMD RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01 PAUL DIONNE
002 2016-01-01 PAUL DIONNE
002 2015-01-01 PAUL DIONNE
002 2014-01-01 PAUL DIONNE
002 2014-01-01 PAUL DIONNE PAUL DIONNE 2015-09-15
002 2013-01-01 PAUL DIONNE PAUL DIONNE 2014-09-03
002 2012-01-01 PAUL DIONNE
002 2011-01-01 PAUL DIONNE
002 2009-01-01 PAUL DIONNE

Plan Statistics for PAUL L. DIONNE, DMD RETIREMENT PLAN

401k plan membership statisitcs for PAUL L. DIONNE, DMD RETIREMENT PLAN

Measure Date Value
2022: PAUL L. DIONNE, DMD RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 3
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 2
Total of all active and inactive participants 2022-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 5
Number of participants with account balances 2022-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: PAUL L. DIONNE, DMD RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 3
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 6
Total of all active and inactive participants 2021-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 9
Number of participants with account balances 2021-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: PAUL L. DIONNE, DMD RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 3
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 6
Total of all active and inactive participants 2020-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 9
Number of participants with account balances 2020-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: PAUL L. DIONNE, DMD RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 3
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 6
Total of all active and inactive participants 2019-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 9
Number of participants with account balances 2019-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: PAUL L. DIONNE, DMD RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 3
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 5
Total of all active and inactive participants 2018-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 8
Number of participants with account balances 2018-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: PAUL L. DIONNE, DMD RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 3
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 5
Total of all active and inactive participants 2017-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 8
Number of participants with account balances 2017-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 1
2016: PAUL L. DIONNE, DMD RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 3
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 4
Total of all active and inactive participants 2016-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 7
Number of participants with account balances 2016-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: PAUL L. DIONNE, DMD RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 3
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 3
Total of all active and inactive participants 2015-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 6
Number of participants with account balances 2015-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: PAUL L. DIONNE, DMD RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 3
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 2
Total of all active and inactive participants 2014-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 5
Number of participants with account balances 2014-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: PAUL L. DIONNE, DMD RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 3
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 5
Number of participants with account balances 2013-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: PAUL L. DIONNE, DMD RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 3
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 1
Total of all active and inactive participants 2012-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 4
Number of participants with account balances 2012-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: PAUL L. DIONNE, DMD RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 3
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 3
Number of participants with account balances 2011-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: PAUL L. DIONNE, DMD RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 3
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 0
Total of all active and inactive participants 2009-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 3
Number of participants with account balances 2009-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2022: PAUL L. DIONNE, DMD RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	3
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	2
Total of all active and inactive participants	2022-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	5
Number of participants with account balances	2022-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: PAUL L. DIONNE, DMD RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	3
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	6
Total of all active and inactive participants	2021-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	9
Number of participants with account balances	2021-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: PAUL L. DIONNE, DMD RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	3
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	6
Total of all active and inactive participants	2020-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	9
Number of participants with account balances	2020-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: PAUL L. DIONNE, DMD RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	3
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	6
Total of all active and inactive participants	2019-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	9
Number of participants with account balances	2019-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: PAUL L. DIONNE, DMD RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	3
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	5
Total of all active and inactive participants	2018-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	8
Number of participants with account balances	2018-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: PAUL L. DIONNE, DMD RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	3
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	5
Total of all active and inactive participants	2017-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	8
Number of participants with account balances	2017-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	1
2016: PAUL L. DIONNE, DMD RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	3
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	4
Total of all active and inactive participants	2016-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	7
Number of participants with account balances	2016-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: PAUL L. DIONNE, DMD RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	3
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	3
Total of all active and inactive participants	2015-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	6
Number of participants with account balances	2015-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: PAUL L. DIONNE, DMD RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	3
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	2
Total of all active and inactive participants	2014-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	5
Number of participants with account balances	2014-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: PAUL L. DIONNE, DMD RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	3
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	5
Number of participants with account balances	2013-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: PAUL L. DIONNE, DMD RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	3
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	1
Total of all active and inactive participants	2012-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	4
Number of participants with account balances	2012-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: PAUL L. DIONNE, DMD RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	3
Number of participants with account balances	2011-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: PAUL L. DIONNE, DMD RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	3
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	0
Total of all active and inactive participants	2009-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	3
Number of participants with account balances	2009-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on PAUL L. DIONNE, DMD RETIREMENT PLAN

Measure	Date	Value
2022 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2022 401k financial data
Transfers to/from the plan	2022-12-31	$0
Total plan liabilities at end of year	2022-12-31	$0
Total plan liabilities at beginning of year	2022-12-31	$0
Total income from all sources	2022-12-31	$-249,033
Expenses. Total of all expenses incurred	2022-12-31	$29,908
Benefits paid (including direct rollovers)	2022-12-31	$0
Total plan assets at end of year	2022-12-31	$1,913,029
Total plan assets at beginning of year	2022-12-31	$2,191,970
Total contributions received or receivable from participants	2022-12-31	$0
Expenses. Other expenses not covered elsewhere	2022-12-31	$29,908
Contributions received from other sources (not participants or employers)	2022-12-31	$0
Other income received	2022-12-31	$-287,496
Noncash contributions received	2022-12-31	$0
Net income (gross income less expenses)	2022-12-31	$-278,941
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$1,913,029
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$2,191,970
Total contributions received or receivable from employer(s)	2022-12-31	$38,463
Value of certain deemed distributions of participant loans	2022-12-31	$0
Value of corrective distributions	2022-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$0
2021 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2021 401k financial data
Transfers to/from the plan	2021-12-31	$0
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$385,735
Expenses. Total of all expenses incurred	2021-12-31	$29,474
Benefits paid (including direct rollovers)	2021-12-31	$0
Total plan assets at end of year	2021-12-31	$2,191,970
Total plan assets at beginning of year	2021-12-31	$1,835,709
Total contributions received or receivable from participants	2021-12-31	$0
Expenses. Other expenses not covered elsewhere	2021-12-31	$29,474
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$347,092
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$356,261
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$2,191,970
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$1,835,709
Total contributions received or receivable from employer(s)	2021-12-31	$38,643
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
2020 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2020 401k financial data
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$309,858
Expenses. Total of all expenses incurred	2020-12-31	$30,331
Benefits paid (including direct rollovers)	2020-12-31	$857
Total plan assets at end of year	2020-12-31	$1,835,709
Total plan assets at beginning of year	2020-12-31	$1,556,182
Total contributions received or receivable from participants	2020-12-31	$0
Expenses. Other expenses not covered elsewhere	2020-12-31	$29,474
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$270,065
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$279,527
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$1,835,709
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$1,556,182
Total contributions received or receivable from employer(s)	2020-12-31	$39,793
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$303,253
Expenses. Total of all expenses incurred	2019-12-31	$29,474
Benefits paid (including direct rollovers)	2019-12-31	$0
Total plan assets at end of year	2019-12-31	$1,556,182
Total plan assets at beginning of year	2019-12-31	$1,282,403
Total contributions received or receivable from participants	2019-12-31	$0
Expenses. Other expenses not covered elsewhere	2019-12-31	$29,474
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$268,253
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$273,779
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$1,556,182
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$1,282,403
Total contributions received or receivable from employer(s)	2019-12-31	$35,000
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2018 401k financial data
Transfers to/from the plan	2018-12-31	$0
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$0
Total income from all sources	2018-12-31	$44,792
Expenses. Total of all expenses incurred	2018-12-31	$29,474
Benefits paid (including direct rollovers)	2018-12-31	$0
Total plan assets at end of year	2018-12-31	$1,282,403
Total plan assets at beginning of year	2018-12-31	$1,267,085
Total contributions received or receivable from participants	2018-12-31	$0
Expenses. Other expenses not covered elsewhere	2018-12-31	$29,474
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$-12,128
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$15,318
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$1,282,403
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$1,267,085
Total contributions received or receivable from employer(s)	2018-12-31	$56,920
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2017 401k financial data
Transfers to/from the plan	2017-12-31	$0
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$221,205
Expenses. Total of all expenses incurred	2017-12-31	$46,837
Benefits paid (including direct rollovers)	2017-12-31	$17,363
Total plan assets at end of year	2017-12-31	$1,267,085
Total plan assets at beginning of year	2017-12-31	$1,092,717
Total contributions received or receivable from participants	2017-12-31	$0
Expenses. Other expenses not covered elsewhere	2017-12-31	$29,474
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$201,205
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$174,368
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$1,267,085
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$1,092,717
Total contributions received or receivable from employer(s)	2017-12-31	$20,000
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$114,090
Expenses. Total of all expenses incurred	2016-12-31	$19,474
Benefits paid (including direct rollovers)	2016-12-31	$0
Total plan assets at end of year	2016-12-31	$1,092,717
Total plan assets at beginning of year	2016-12-31	$998,101
Total contributions received or receivable from participants	2016-12-31	$0
Expenses. Other expenses not covered elsewhere	2016-12-31	$19,474
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$94,090
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$94,616
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,092,717
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$998,101
Total contributions received or receivable from employer(s)	2016-12-31	$20,000
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$55,876
Expenses. Total of all expenses incurred	2015-12-31	$19,474
Benefits paid (including direct rollovers)	2015-12-31	$0
Total plan assets at end of year	2015-12-31	$998,101
Total plan assets at beginning of year	2015-12-31	$961,699
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$19,474
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$35,876
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$36,402
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$998,101
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$961,699
Total contributions received or receivable from employer(s)	2015-12-31	$20,000
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$98,547
Expenses. Total of all expenses incurred	2014-12-31	$33,021
Benefits paid (including direct rollovers)	2014-12-31	$13,547
Total plan assets at end of year	2014-12-31	$959,699
Total plan assets at beginning of year	2014-12-31	$894,173
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$19,474
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$78,547
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$65,526
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$959,699
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$894,173
Total contributions received or receivable from employer(s)	2014-12-31	$20,000
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$202,938
Expenses. Total of all expenses incurred	2013-12-31	$19,474
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$894,173
Total plan assets at beginning of year	2013-12-31	$710,709
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$19,474
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$182,938
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$183,464
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$894,173
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$710,709
Total contributions received or receivable from employer(s)	2013-12-31	$20,000
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$117,815
Expenses. Total of all expenses incurred	2012-12-31	$19,474
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$710,709
Total plan assets at beginning of year	2012-12-31	$612,368
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$19,474
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$97,815
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$98,341
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$710,709
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$612,368
Total contributions received or receivable from employer(s)	2012-12-31	$20,000
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$32,069
Expenses. Total of all expenses incurred	2011-12-31	$19,474
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$612,368
Total plan assets at beginning of year	2011-12-31	$599,773
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$19,474
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$848
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$12,595
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$612,368
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$599,773
Total contributions received or receivable from employer(s)	2011-12-31	$31,221
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : PAUL L. DIONNE, DMD RETIREMENT PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$19,474
Total plan liabilities at beginning of year	2010-12-31	$19,474
Total income from all sources	2010-12-31	$105,059
Expenses. Total of all expenses incurred	2010-12-31	$19,474
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$619,247
Total plan assets at beginning of year	2010-12-31	$533,662
Total contributions received or receivable from participants	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$19,474
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$79,150
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$85,585
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$599,773
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$514,188
Total contributions received or receivable from employer(s)	2010-12-31	$25,909
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : PAUL L. DIONNE, DMD RETIREMENT PLAN 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

Form 5500 Responses for PAUL L. DIONNE, DMD RETIREMENT PLAN

2022: PAUL L. DIONNE, DMD RETIREMENT 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: PAUL L. DIONNE, DMD RETIREMENT 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: PAUL L. DIONNE, DMD RETIREMENT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: PAUL L. DIONNE, DMD RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: PAUL L. DIONNE, DMD RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: PAUL L. DIONNE, DMD RETIREMENT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: PAUL L. DIONNE, DMD RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: PAUL L. DIONNE, DMD RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: PAUL L. DIONNE, DMD RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: PAUL L. DIONNE, DMD RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PAUL L. DIONNE, DMD RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PAUL L. DIONNE, DMD RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: PAUL L. DIONNE, DMD RETIREMENT PLAN 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 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

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

5911498

Policy instance

Insurance contract or identification number	5911498
Number of Individuals Covered	1
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $898
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $200
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

5911498

Policy instance

Insurance contract or identification number	5911498
Number of Individuals Covered	1
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $1,198
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $500
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

5911498

Policy instance

Insurance contract or identification number	5911498
Number of Individuals Covered	1
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,898
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $500
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )

Policy contract number

5911498

Policy instance

Insurance contract or identification number	5911498
Number of Individuals Covered	3
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	PAUL L. DIONNE, DMD
Employer identification number (EIN):	223246865
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)