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| Plan Name | THE REJUVENATION CENTER 401K RETIREMENT PLAN |
| Plan identification number | 001 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
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| Company Name: | MIDWEST SPINE CLINIC LLC |
| Employer identification number (EIN): | 470845112 |
| 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 | JAMES R STAHELI | JAMES R STAHELI | 2011-07-25 | |
| 001 | 2009-01-01 | JAMES R STAHELI | JAMES R STAHELI | 2010-10-11 |
| Measure | Date | Value |
|---|---|---|
| 2010: THE REJUVENATION CENTER 401K RETIREMENT PLAN 2010 401k membership | ||
| Total participants, beginning-of-year | 2010-01-01 | 28 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 0 |
| Number of participants with account balances | 2010-01-01 | 0 |
| 2009: THE REJUVENATION CENTER 401K RETIREMENT PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 28 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 20 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 8 |
| Total of all active and inactive participants | 2009-01-01 | 28 |
| Total participants | 2009-01-01 | 28 |
| Number of participants with account balances | 2009-01-01 | 28 |
| Measure | Date | Value |
|---|---|---|
| 2010 : THE REJUVENATION CENTER 401K RETIREMENT PLAN 2010 401k financial data | ||
| Total income from all sources | 2010-12-31 | $5,094 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $142,641 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $142,641 |
| Total plan assets at end of year | 2010-12-31 | $0 |
| Total plan assets at beginning of year | 2010-12-31 | $137,547 |
| Total contributions received or receivable from participants | 2010-12-31 | $0 |
| Other income received | 2010-12-31 | $5,094 |
| Net income (gross income less expenses) | 2010-12-31 | $-137,547 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $137,547 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $0 |
| 2010: THE REJUVENATION CENTER 401K RETIREMENT PLAN 2010 form 5500 responses | ||
|---|---|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | This submission is the final filing | Yes |
| 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: THE REJUVENATION CENTER 401K RETIREMENT 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 – 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 |
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