401k Plan data: THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN plan

THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN
Plan identification number	002

THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

THOMAS J. SMALL, M.D., INC. has sponsored the creation of one or more 401k plans.

Company Name: THOMAS J. SMALL, M.D., INC.

Employer identification number (EIN): 351466374

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2012-01-01 THOMAS J. SMALL
002 2011-01-01 THOMAS J. SMALL
002 2010-01-01 THOMAS SMALL
002 2009-01-01 THOMAS J. SMALL, M.D.

Plan id#	Filing Submission Date	Name of Administrator
002	2012-01-01	THOMAS J. SMALL
002	2011-01-01	THOMAS J. SMALL
002	2010-01-01	THOMAS SMALL
002	2009-01-01	THOMAS J. SMALL, M.D.

Plan Statistics for THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN

401k plan membership statisitcs for THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN

Measure Date Value
2012: THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
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 0
Total of all active and inactive participants 2012-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 0
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 2
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 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 2
Number of participants with account balances 2011-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 2
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 0
Total of all active and inactive participants 2010-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 2
Number of participants with account balances 2010-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2
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 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 2
Number of participants with account balances 2009-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2012: THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
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	0
Total of all active and inactive participants	2012-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	0
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2
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	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	2
Number of participants with account balances	2011-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	2
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	0
Total of all active and inactive participants	2010-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	2
Number of participants with account balances	2010-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2
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	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	2
Number of participants with account balances	2009-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN

Measure	Date	Value
2012 : THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$-411,446
Expenses. Total of all expenses incurred	2012-12-31	$225,701
Benefits paid (including direct rollovers)	2012-12-31	$225,701
Total plan assets at end of year	2012-12-31	$0
Total plan assets at beginning of year	2012-12-31	$637,147
Value of fidelity bond covering the plan	2012-12-31	$85,000
Other income received	2012-12-31	$-411,446
Net income (gross income less expenses)	2012-12-31	$-637,147
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$637,147
Assets. Value of participant loans	2012-12-31	$0
Assets. Value of real-estate (other than employer real property)	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 : THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$-72,492
Expenses. Total of all expenses incurred	2011-12-31	$1,425
Total plan assets at end of year	2011-12-31	$637,147
Total plan assets at beginning of year	2011-12-31	$711,064
Value of fidelity bond covering the plan	2011-12-31	$85,000
Other income received	2011-12-31	$-72,492
Net income (gross income less expenses)	2011-12-31	$-73,917
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$637,147
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$711,064
Assets. Value of participant loans	2011-12-31	$130,000
Assets. Value of real-estate (other than employer real property)	2011-12-31	$400,000
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$1,425
2010 : THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$6,457
Expenses. Total of all expenses incurred	2010-12-31	$1,052
Total plan assets at end of year	2010-12-31	$711,064
Total plan assets at beginning of year	2010-12-31	$705,659
Value of fidelity bond covering the plan	2010-12-31	$85,000
Other income received	2010-12-31	$6,457
Net income (gross income less expenses)	2010-12-31	$5,405
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$711,064
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$705,659
Assets. Value of participant loans	2010-12-31	$130,000
Assets. Value of real-estate (other than employer real property)	2010-12-31	$470,000
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$1,052

Form 5500 Responses for THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN

2012: THOMAS J. SMALL, M.D., INC. PROFIT SHARING 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	Yes
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: THOMAS J. SMALL, M.D., INC. PROFIT SHARING 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
2010: THOMAS J. SMALL, M.D., INC. PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
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 – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: THOMAS J. SMALL, M.D., INC. PROFIT SHARING 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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	THOMAS J. SMALL, M.D., INC.
Employer identification number (EIN):	351466374
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)