401k Plan data: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN plan

DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 401k Plan overview

Plan Name	DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN
Plan identification number	502

DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

DENTAL CLINIC OF MARSHFIELD SC has sponsored the creation of one or more 401k plans.

Company Name: DENTAL CLINIC OF MARSHFIELD SC

Employer identification number (EIN): 391093621

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2013-06-01 JAMES DERZON
502 2012-06-01 JAMES DERZON
502 2011-06-01 JAMES DERZON
502 2010-06-01 JAMES DERZON
502 2009-06-01 JAMES DERZON

Plan id#	Filing Submission Date	Name of Administrator
502	2013-06-01	JAMES DERZON
502	2012-06-01	JAMES DERZON
502	2011-06-01	JAMES DERZON
502	2010-06-01	JAMES DERZON
502	2009-06-01	JAMES DERZON

Plan Statistics for DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN

401k plan membership statisitcs for DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN

Measure Date Value
2013: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 104
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 99
Total of all active and inactive participants 2013-06-01 99
2012: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-06-01 105
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 104
Total of all active and inactive participants 2012-06-01 104
2011: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-06-01 108
Total number of active participants reported on line 7a of the Form 5500 2011-06-01 105
Total of all active and inactive participants 2011-06-01 105
2010: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year 2010-06-01 107
Total number of active participants reported on line 7a of the Form 5500 2010-06-01 108
Total of all active and inactive participants 2010-06-01 108
2009: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-06-01 112
Total number of active participants reported on line 7a of the Form 5500 2009-06-01 107
Number of retired or separated participants receiving benefits 2009-06-01 0
Number of other retired or separated participants entitled to future benefits 2009-06-01 0
Total of all active and inactive participants 2009-06-01 107

Measure	Date	Value
2013: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	104
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	99
Total of all active and inactive participants	2013-06-01	99
2012: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	105
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	104
Total of all active and inactive participants	2012-06-01	104
2011: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-06-01	108
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	105
Total of all active and inactive participants	2011-06-01	105
2010: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year	2010-06-01	107
Total number of active participants reported on line 7a of the Form 5500	2010-06-01	108
Total of all active and inactive participants	2010-06-01	108
2009: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-06-01	112
Total number of active participants reported on line 7a of the Form 5500	2009-06-01	107
Number of retired or separated participants receiving benefits	2009-06-01	0
Number of other retired or separated participants entitled to future benefits	2009-06-01	0
Total of all active and inactive participants	2009-06-01	107

Form 5500 Responses for DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN

2013: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2012: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Plan funding arrangement – Insurance	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes
2011: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	Plan funding arrangement – Insurance	Yes
2011-06-01	Plan benefit arrangement – Insurance	Yes
2010: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2010 form 5500 responses
2010-06-01	Type of plan entity	Single employer plan
2010-06-01	Plan funding arrangement – Insurance	Yes
2010-06-01	Plan benefit arrangement – Insurance	Yes
2009: DENTAL CLINIC OF MARSHFIELD LONG-TERM DISABILITY PLAN 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	This submission is the final filing	No
2009-06-01	Plan funding arrangement – Insurance	Yes
2009-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	SGD550069
Policy instance	1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	SGD550069
Policy instance	1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	SGD550069
Policy instance	1
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract number	SGD550069
Policy instance	1

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Company Name:	DENTAL CLINIC OF MARSHFIELD SC
Employer identification number (EIN):	391093621
NAIC Classification:	621210
NAIC Description:	Offices of Dentists