401k Plan data: HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN plan

HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN
Plan identification number	001

HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
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

HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. has sponsored the creation of one or more 401k plans.

Company Name: HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC.

Employer identification number (EIN): 621563599

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2011-01-01 EUGENE F. GULISH, M.D.
001 2009-01-01 EUGENE F. GULISH, M.D. EUGENE F. GULISH, M.D. 2010-05-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2011-01-01	EUGENE F. GULISH, M.D.
001	2009-01-01	EUGENE F. GULISH, M.D.		EUGENE F. GULISH, M.D.	2010-05-19

Plan Statistics for HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN

Measure Date Value
2011: HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 25
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 21
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 2
Total of all active and inactive participants 2011-01-01 23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 23
Number of participants with account balances 2011-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 1
2009: HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING 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 23
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 1
Total of all active and inactive participants 2009-01-01 24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 24
Number of participants with account balances 2009-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2011: HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	25
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	21
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	2
Total of all active and inactive participants	2011-01-01	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	23
Number of participants with account balances	2011-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	1
2009: HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING 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	23
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	1
Total of all active and inactive participants	2009-01-01	24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	24
Number of participants with account balances	2009-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN

Measure	Date	Value
2011 : HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$807
Total income from all sources	2011-12-31	$193,567
Expenses. Total of all expenses incurred	2011-12-31	$156,005
Benefits paid (including direct rollovers)	2011-12-31	$153,272
Total plan assets at end of year	2011-12-31	$3,519,061
Total plan assets at beginning of year	2011-12-31	$3,482,306
Value of fidelity bond covering the plan	2011-12-31	$500,000
Total contributions received or receivable from participants	2011-12-31	$58,981
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$94,830
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$37,562
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$3,519,061
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$3,481,499
Assets. Value of participant loans	2011-12-31	$0
Assets. Value of real-estate (other than employer real property)	2011-12-31	$40,000
Total contributions received or receivable from employer(s)	2011-12-31	$39,756
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$2,733
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$807
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$476,339
Expenses. Total of all expenses incurred	2010-12-31	$156,197
Benefits paid (including direct rollovers)	2010-12-31	$153,926
Total plan assets at end of year	2010-12-31	$3,482,306
Total plan assets at beginning of year	2010-12-31	$3,161,357
Value of fidelity bond covering the plan	2010-12-31	$500,000
Total contributions received or receivable from participants	2010-12-31	$57,310
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	$378,278
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$320,142
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$3,481,499
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$3,161,357
Assets. Value of participant loans	2010-12-31	$50,000
Assets. Value of real-estate (other than employer real property)	2010-12-31	$54,000
Total contributions received or receivable from employer(s)	2010-12-31	$40,751
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	$2,271
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN

2011: HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	HENRY COUNTY ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, INC.
Employer identification number (EIN):	621563599
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)