401k Plan data: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN plan

ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN
Plan identification number	001

ROBERT J. ANDREW, D.D.S., P.S. 401(K) 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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

ROBERT J. ANDREW, D.D.S., P.S. has sponsored the creation of one or more 401k plans.

Company Name: ROBERT J. ANDREW, D.D.S., P.S.

Employer identification number (EIN): 910870481

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Additional information about ROBERT J. ANDREW, D.D.S., P.S.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 1971-09-13

Company Identification Number: 600049375

Legal Registered Office Address: 12002 PACIFIC AVE

TACOMA
United States of America (USA)
98444

More information about ROBERT J. ANDREW, D.D.S., P.S.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01
001 2015-01-01
001 2014-01-01 ROBERT ANDREW
001 2013-01-01 ROBERT ANDREW
001 2012-01-01 ROBERT ANDREW
001 2011-01-01 ROBERT ANDREW
001 2010-01-01 TODD HUGHES
001 2009-01-01 ROBERT J. ANDREW D.D.S.,P.S.

Plan Statistics for ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN

Measure Date Value
2016: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
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 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
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 0
Total of all active and inactive participants 2015-01-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 1
Number of participants with account balances 2015-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
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 8
Total of all active and inactive participants 2014-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 8
Number of participants with account balances 2014-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 6
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 2
Total of all active and inactive participants 2013-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 8
2012: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 4
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 2
Total of all active and inactive participants 2012-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 6
Number of participants with account balances 2012-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
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 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 6
Number of participants with account balances 2011-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 2
2010: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 6
Total of all active and inactive participants 2010-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 6
Number of participants with account balances 2010-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 5
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 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 6
Number of participants with account balances 2009-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2016: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
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	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
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	0
Total of all active and inactive participants	2015-01-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	1
Number of participants with account balances	2015-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
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	8
Total of all active and inactive participants	2014-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	8
Number of participants with account balances	2014-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	6
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	2
Total of all active and inactive participants	2013-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	8
2012: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	4
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	2
Total of all active and inactive participants	2012-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	6
Number of participants with account balances	2012-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
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	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	6
Number of participants with account balances	2011-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	2
2010: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	6
Total of all active and inactive participants	2010-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	6
Number of participants with account balances	2010-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	5
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	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	6
Number of participants with account balances	2009-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2016 : ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources	2016-03-31	$27,027
Expenses. Total of all expenses incurred	2016-03-31	$611,932
Benefits paid (including direct rollovers)	2016-03-31	$611,907
Total plan assets at end of year	2016-03-31	$0
Total plan assets at beginning of year	2016-03-31	$584,905
Value of fidelity bond covering the plan	2016-03-31	$275,000
Other income received	2016-03-31	$27,027
Net income (gross income less expenses)	2016-03-31	$-584,905
Net plan assets at end of year (total assets less liabilities)	2016-03-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-03-31	$584,905
Assets. Value of assets in partnership/joint-venture interests	2016-03-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-03-31	$25
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-03-31	$0
2015 : ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$12,789
Expenses. Total of all expenses incurred	2015-12-31	$2,069,474
Benefits paid (including direct rollovers)	2015-12-31	$2,050,965
Total plan assets at end of year	2015-12-31	$584,905
Total plan assets at beginning of year	2015-12-31	$2,641,590
Value of fidelity bond covering the plan	2015-12-31	$275,000
Other income received	2015-12-31	$12,789
Net income (gross income less expenses)	2015-12-31	$-2,056,685
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$584,905
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$2,641,590
Assets. Value of participant loans	2015-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$6,825
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$18,509
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$245,839
Expenses. Total of all expenses incurred	2014-12-31	$218,039
Benefits paid (including direct rollovers)	2014-12-31	$199,920
Total plan assets at end of year	2014-12-31	$2,641,590
Total plan assets at beginning of year	2014-12-31	$2,613,790
Value of fidelity bond covering the plan	2014-12-31	$275,000
Total contributions received or receivable from participants	2014-12-31	$16,600
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$176,570
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$27,800
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$2,641,590
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$2,613,790
Assets. Value of participant loans	2014-12-31	$34,995
Assets. Value of assets in partnership/joint-venture interests	2014-12-31	$10,500
Total contributions received or receivable from employer(s)	2014-12-31	$52,669
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$18,119
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$292,420
Expenses. Total of all expenses incurred	2013-12-31	$99,300
Benefits paid (including direct rollovers)	2013-12-31	$81,318
Total plan assets at end of year	2013-12-31	$2,613,790
Total plan assets at beginning of year	2013-12-31	$2,420,670
Value of fidelity bond covering the plan	2013-12-31	$275,000
Total contributions received or receivable from participants	2013-12-31	$25,875
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$236,545
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$193,120
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,613,790
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,420,670
Assets. Value of participant loans	2013-12-31	$36,444
Assets. Value of assets in partnership/joint-venture interests	2013-12-31	$14,600
Total contributions received or receivable from employer(s)	2013-12-31	$30,000
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$17,982
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$257,706
Expenses. Total of all expenses incurred	2012-12-31	$18,138
Benefits paid (including direct rollovers)	2012-12-31	$1,562
Total plan assets at end of year	2012-12-31	$2,420,670
Total plan assets at beginning of year	2012-12-31	$2,181,102
Value of fidelity bond covering the plan	2012-12-31	$275,000
Total contributions received or receivable from participants	2012-12-31	$22,925
Other income received	2012-12-31	$204,781
Net income (gross income less expenses)	2012-12-31	$239,568
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,420,670
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,181,102
Assets. Value of participant loans	2012-12-31	$39,632
Assets. Value of assets in partnership/joint-venture interests	2012-12-31	$20,000
Total contributions received or receivable from employer(s)	2012-12-31	$30,000
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$16,576
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : ROBERT J. ANDREW, D.D.S., P.S. 401(K) 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	$0
Total income from all sources	2011-12-31	$68,998
Expenses. Total of all expenses incurred	2011-12-31	$16,361
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$2,181,102
Total plan assets at beginning of year	2011-12-31	$2,128,465
Value of fidelity bond covering the plan	2011-12-31	$275,000
Total contributions received or receivable from participants	2011-12-31	$38,244
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	$754
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$52,637
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,181,102
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,128,465
Assets. Value of participant loans	2011-12-31	$42,689
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$20,000
Total contributions received or receivable from employer(s)	2011-12-31	$30,000
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	$16,361
2010 : ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$231,238
Expenses. Total of all expenses incurred	2010-12-31	$20,661
Benefits paid (including direct rollovers)	2010-12-31	$655
Total plan assets at end of year	2010-12-31	$2,128,465
Total plan assets at beginning of year	2010-12-31	$1,917,888
Value of fidelity bond covering the plan	2010-12-31	$220,000
Total contributions received or receivable from participants	2010-12-31	$36,150
Other income received	2010-12-31	$151,238
Net income (gross income less expenses)	2010-12-31	$210,577
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,128,465
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,917,888
Assets. Value of participant loans	2010-12-31	$45,663
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$20,000
Total contributions received or receivable from employer(s)	2010-12-31	$43,850
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$20,006

Form 5500 Responses for ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING PLAN

2016: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING 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	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: ROBERT J. ANDREW, D.D.S., P.S. 401(K) 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: ROBERT J. ANDREW, D.D.S., P.S. 401(K) 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: ROBERT J. ANDREW, D.D.S., P.S. 401(K) 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: ROBERT J. ANDREW, D.D.S., P.S. 401(K) 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
2011: ROBERT J. ANDREW, D.D.S., P.S. 401(K) 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 – 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: ROBERT J. ANDREW, D.D.S., P.S. 401(K) PROFIT SHARING 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: ROBERT J. ANDREW, D.D.S., P.S. 401(K) 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 – 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

Insurance Providers Used on plan

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

LP1117879

Policy instance

Insurance contract or identification number	LP1117879
Number of Individuals Covered	1
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $92
Total amount of fees paid to insurance company	USD $0
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 $46
Insurance broker organization code?	4
Insurance broker name	MARTIN E. JUERGENS

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

LP1117879

Policy instance

Insurance contract or identification number	LP1117879
Number of Individuals Covered	8
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $674
Total amount of fees paid to insurance company	USD $0
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 $337
Insurance broker organization code?	4
Insurance broker name	MARTIN E. JUERGENS

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

LP1117879

Policy instance

Insurance contract or identification number	LP1117879
Number of Individuals Covered	7
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $546
Total amount of fees paid to insurance company	USD $0
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 $273
Insurance broker organization code?	4
Insurance broker name	MARTIN E. JUERGENS

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

LP1117879

Policy instance

Insurance contract or identification number	LP1117879
Number of Individuals Covered	7
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $265
Total amount of fees paid to insurance company	USD $0
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 $150
Insurance broker organization code?	4
Insurance broker name	MARTIN E. JUERGENS

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Company Name:	ROBERT J. ANDREW, D.D.S., P.S.
Employer identification number (EIN):	910870481
NAIC Classification:	621210
NAIC Description:	Offices of Dentists

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	1971-09-13
Company Identification Number:	600049375
Legal Registered Office Address:	12002 PACIFIC AVE TACOMA United States of America (USA) 98444