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| Plan Name | BRIAN J. SHAHEEN, M.D., S.C. 401K PLAN |
| Plan identification number | 001 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
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| Company Name: | BRIAN J. SHAHEEN, M.D., S.C. |
| Employer identification number (EIN): | 371410004 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 001 | 2010-01-01 | MARY JO HOLLENSBE | |||
| 001 | 2009-01-01 | BRIAN SHAHEEN |
| Measure | Date | Value |
|---|---|---|
| 2010 : BRIAN J. SHAHEEN, M.D., S.C. 401K PLAN 2010 401k financial data | ||
| Total income from all sources | 2010-09-08 | $19,811 |
| Expenses. Total of all expenses incurred | 2010-09-08 | $364,693 |
| Benefits paid (including direct rollovers) | 2010-09-08 | $364,693 |
| Total plan assets at end of year | 2010-09-08 | $0 |
| Total plan assets at beginning of year | 2010-09-08 | $344,882 |
| Value of fidelity bond covering the plan | 2010-09-08 | $50,000 |
| Total contributions received or receivable from participants | 2010-09-08 | $19,477 |
| Other income received | 2010-09-08 | $-3,108 |
| Net income (gross income less expenses) | 2010-09-08 | $-344,882 |
| Net plan assets at end of year (total assets less liabilities) | 2010-09-08 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-09-08 | $344,882 |
| 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 | 2010-09-08 | $1,493 |
| Total contributions received or receivable from employer(s) | 2010-09-08 | $3,442 |
| 2010: BRIAN J. SHAHEEN, M.D., S.C. 401K 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 | Yes |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 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: BRIAN J. SHAHEEN, M.D., S.C. 401K PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
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