401k Plan data: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN plan

NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 401k Plan overview

Plan Name	NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN
Plan identification number	002

NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).
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

NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. has sponsored the creation of one or more 401k plans.

Company Name: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C.

Employer identification number (EIN): 421016344

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2017-01-01
002 2016-01-01
002 2015-01-01
002 2014-01-01 RUSSELL SNOW, EA, CPC, MSPA 2015-10-09
002 2013-01-01 RUSSELL J. SNOW, EA, CPC, MSPA 2014-09-17
002 2012-01-01 RUSSELL SNOW, EA, CPC, MSPA 2013-09-25
002 2011-01-01 RUSSELL J. SNOW, EA, CPC, MSPA
002 2010-01-01 RUSSELL J. SNOW, EA, CPC, MSPA
002 2009-10-01 RUSSELL J. SNOW
002 2008-10-01

Plan Statistics for NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN

401k plan membership statisitcs for NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN

Measure Date Value
2017: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
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 0
Total of all active and inactive participants 2017-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 10
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 1
Total of all active and inactive participants 2016-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 10
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 4
Total of all active and inactive participants 2015-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2011: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 10
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 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 10
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 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 10
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 10
Number of retired or separated participants receiving benefits 2009-10-01 0
Number of other retired or separated participants entitled to future benefits 2009-10-01 0
Total of all active and inactive participants 2009-10-01 10
Total participants 2009-10-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-10-01 0

Measure	Date	Value
2017: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
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	0
Total of all active and inactive participants	2017-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	10
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	1
Total of all active and inactive participants	2016-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	10
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	4
Total of all active and inactive participants	2015-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2011: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	10
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	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	10
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	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	10
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	10
Number of retired or separated participants receiving benefits	2009-10-01	0
Number of other retired or separated participants entitled to future benefits	2009-10-01	0
Total of all active and inactive participants	2009-10-01	10
Total participants	2009-10-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-10-01	0

Financial Data on NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN

Measure	Date	Value
2017 : NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2017 401k financial data
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	$31,757
Expenses. Total of all expenses incurred	2017-12-31	$660,177
Benefits paid (including direct rollovers)	2017-12-31	$660,177
Total plan assets at end of year	2017-12-31	$0
Total plan assets at beginning of year	2017-12-31	$628,420
Value of fidelity bond covering the plan	2017-12-31	$130,000
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Other income received	2017-12-31	$31,757
Net income (gross income less expenses)	2017-12-31	$-628,420
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$628,420
Assets. Value of assets in partnership/joint-venture interests	2017-12-31	$0
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	$46,000
2016 : NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT 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	$45,423
Expenses. Total of all expenses incurred	2016-12-31	$257,520
Benefits paid (including direct rollovers)	2016-12-31	$250,958
Total plan assets at end of year	2016-12-31	$628,420
Total plan assets at beginning of year	2016-12-31	$840,517
Value of fidelity bond covering the plan	2016-12-31	$130,000
Total contributions received or receivable from participants	2016-12-31	$0
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$45,423
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$-212,097
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$628,420
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$840,517
Assets. Value of assets in partnership/joint-venture interests	2016-12-31	$46,000
Total contributions received or receivable from employer(s)	2016-12-31	$0
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	$6,562
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT 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	$43,171
Expenses. Total of all expenses incurred	2015-12-31	$18,318
Benefits paid (including direct rollovers)	2015-12-31	$0
Total plan assets at end of year	2015-12-31	$840,517
Total plan assets at beginning of year	2015-12-31	$815,664
Value of fidelity bond covering the plan	2015-12-31	$130,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$43,171
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$24,853
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$840,517
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$815,664
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$46,000
Total contributions received or receivable from employer(s)	2015-12-31	$0
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	$18,318
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2011 : NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2011 401k financial data
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	$48,211
Expenses. Total of all expenses incurred	2011-12-31	$0
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$456,363
Total plan assets at beginning of year	2011-12-31	$408,152
Total contributions received or receivable from participants	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-24,754
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$48,211
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$456,363
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$408,152
Total contributions received or receivable from employer(s)	2011-12-31	$72,965
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 : NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$107,842
Expenses. Total of all expenses incurred	2010-12-31	$0
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$408,152
Total plan assets at beginning of year	2010-12-31	$300,310
Total contributions received or receivable from participants	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$-20,333
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$107,842
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$408,152
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$300,310
Total contributions received or receivable from employer(s)	2010-12-31	$128,175
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 : NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT 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 NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN

2017: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT 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	Yes
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: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT 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 – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT 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 – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2011: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT 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 – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT 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 – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan funding arrangement – Trust	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement - Trust	Yes
2008: NORTH IOWA ORAL SURGERY ASSOCIATES, P.C. DEFINED BENEFIT PLAN 2008 form 5500 responses
2008-10-01	Type of plan entity	Single employer plan
2008-10-01	Submission has been amended	No
2008-10-01	This submission is the final filing	No
2008-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-10-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

VF518

Policy instance

Insurance contract or identification number	VF518
Number of Individuals Covered	6
Insurance policy start date	2016-01-01
Insurance policy end date	2016-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	ROBERT S. GRAHAM

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

VF518

Policy instance

Insurance contract or identification number	VF518
Number of Individuals Covered	7
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	ROBERT S. GRAHAM

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

VF518

Policy instance

Insurance contract or identification number	VF518
Number of Individuals Covered	7
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,011
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

VF518

Policy instance

Insurance contract or identification number	VF518
Number of Individuals Covered	7
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,011
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,011
Insurance broker organization code?	3
Insurance broker name	ROBERT S. GRAHAM

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Company Name:	NORTH IOWA ORAL SURGERY ASSOCIATES, P.C.
Employer identification number (EIN):	421016344
NAIC Classification:	621210
NAIC Description:	Offices of Dentists