401k Plan data: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN plan

THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN
Plan identification number	002

THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. has sponsored the creation of one or more 401k plans.

Company Name: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC.

Employer identification number (EIN): 621516989

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2018-01-01 DR. CHARLES WITKOWSKI 2019-07-01
002 2018-01-01 DR. CHARLES WITKOWSKI 2019-09-12
002 2017-01-01 DR. CHARLES WITKOWSKI 2018-07-23
002 2016-01-01 DR. CHARLES WITKOWSKI 2017-09-21
002 2015-01-01 DR. CHARLES WITKOWSKI
002 2014-01-01 DR. CHARLES WITKOWSKI
002 2013-01-01 DR. CHARLES WITKOWSKI
002 2012-01-01 DR. CHARLES WITKOWSKI
002 2011-01-01 DR CHARLES WITKOWSKI 2012-10-11
002 2010-01-01 DR CHARLES WITKOWSKI 2011-09-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2018-01-01	DR. CHARLES WITKOWSKI	2019-07-01
002	2018-01-01	DR. CHARLES WITKOWSKI	2019-09-12
002	2017-01-01	DR. CHARLES WITKOWSKI	2018-07-23
002	2016-01-01	DR. CHARLES WITKOWSKI	2017-09-21
002	2015-01-01	DR. CHARLES WITKOWSKI
002	2014-01-01	DR. CHARLES WITKOWSKI
002	2013-01-01	DR. CHARLES WITKOWSKI
002	2012-01-01	DR. CHARLES WITKOWSKI
002	2011-01-01	DR CHARLES WITKOWSKI	2012-10-11
002	2010-01-01	DR CHARLES WITKOWSKI	2011-09-10

Plan Statistics for THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN

Measure Date Value
2015: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING 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 9
Number of retired or separated participants receiving benefits 2015-01-01 1
Number of other retired or separated participants entitled to future benefits 2015-01-01 2
Total of all active and inactive participants 2015-01-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 12
Number of participants with account balances 2015-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 3
2014: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 13
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 13
Number of participants with account balances 2014-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 10
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 10
Number of participants with account balances 2013-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 10
Number of retired or separated participants receiving benefits 2012-01-01 1
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 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 11
Number of participants with account balances 2012-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2015: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING 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	9
Number of retired or separated participants receiving benefits	2015-01-01	1
Number of other retired or separated participants entitled to future benefits	2015-01-01	2
Total of all active and inactive participants	2015-01-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	12
Number of participants with account balances	2015-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	3
2014: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	13
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	13
Number of participants with account balances	2014-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	10
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	10
Number of participants with account balances	2013-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	10
Number of retired or separated participants receiving benefits	2012-01-01	1
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	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	11
Number of participants with account balances	2012-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN

Measure	Date	Value
2015 : THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$80,240
Expenses. Total of all expenses incurred	2015-12-31	$505,999
Benefits paid (including direct rollovers)	2015-12-31	$502,229
Total plan assets at end of year	2015-12-31	$1,375,146
Total plan assets at beginning of year	2015-12-31	$1,800,905
Value of fidelity bond covering the plan	2015-12-31	$300,000
Total contributions received or receivable from participants	2015-12-31	$39,597
Other income received	2015-12-31	$1,896
Net income (gross income less expenses)	2015-12-31	$-425,759
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,375,146
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,800,905
Total contributions received or receivable from employer(s)	2015-12-31	$38,747
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$3,770
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$202,460
Expenses. Total of all expenses incurred	2014-12-31	$4,796
Benefits paid (including direct rollovers)	2014-12-31	$82
Total plan assets at end of year	2014-12-31	$1,800,905
Total plan assets at beginning of year	2014-12-31	$1,603,241
Value of fidelity bond covering the plan	2014-12-31	$300,000
Total contributions received or receivable from participants	2014-12-31	$55,402
Other income received	2014-12-31	$63,876
Net income (gross income less expenses)	2014-12-31	$197,664
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,800,905
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,603,241
Total contributions received or receivable from employer(s)	2014-12-31	$83,182
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$4,714
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$391,840
Expenses. Total of all expenses incurred	2013-12-31	$155,164
Benefits paid (including direct rollovers)	2013-12-31	$151,742
Total plan assets at end of year	2013-12-31	$1,603,241
Total plan assets at beginning of year	2013-12-31	$1,366,565
Value of fidelity bond covering the plan	2013-12-31	$300,000
Total contributions received or receivable from participants	2013-12-31	$54,017
Other income received	2013-12-31	$257,910
Net income (gross income less expenses)	2013-12-31	$236,676
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,603,241
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,366,565
Total contributions received or receivable from employer(s)	2013-12-31	$79,913
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$3,422
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$303,529
Expenses. Total of all expenses incurred	2012-12-31	$256,172
Benefits paid (including direct rollovers)	2012-12-31	$252,894
Total plan assets at end of year	2012-12-31	$1,366,565
Total plan assets at beginning of year	2012-12-31	$1,319,208
Value of fidelity bond covering the plan	2012-12-31	$300,000
Total contributions received or receivable from participants	2012-12-31	$53,085
Other income received	2012-12-31	$173,050
Net income (gross income less expenses)	2012-12-31	$47,357
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,366,565
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,319,208
Total contributions received or receivable from employer(s)	2012-12-31	$77,394
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$3,278
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0

Form 5500 Responses for THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN

2015: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING 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
2014: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, 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	No
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 – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

57263

Policy instance

Insurance contract or identification number	57263
Number of Individuals Covered	11
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,882
Total amount of fees paid to insurance company	USD $732
Are there contracts with allocated funds for individual policies?	No
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 $7,882
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	QUALIFIED PLAN ADMINISTRATORS INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

57263

Policy instance

Insurance contract or identification number	57263
Number of Individuals Covered	12
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,346
Total amount of fees paid to insurance company	USD $1,604
Are there contracts with allocated funds for individual policies?	No
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 $8,346
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	QUALIFIED PLAN ADMINISTRATORS INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

57263

Policy instance

Insurance contract or identification number	57263
Number of Individuals Covered	10
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,123
Total amount of fees paid to insurance company	USD $794
Are there contracts with allocated funds for individual policies?	No
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 $7,123
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name	QUALIFIED PLAN ADMINISTRATORS INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

57263

Policy instance

Insurance contract or identification number	57263
Number of Individuals Covered	10
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,849
Total amount of fees paid to insurance company	USD $774
Are there contracts with allocated funds for individual policies?	No
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 $6,849
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	BROKER COMMISSION
Insurance broker organization code?	3
Insurance broker name

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Company Name:	THE REGIONAL CENTER FOR ORAL & MAXILLOFACIAL SURGERY, INC.
Employer identification number (EIN):	621516989
NAIC Classification:	621210
NAIC Description:	Offices of Dentists