401k Plan data: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN plan

JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN 401k Plan overview

Plan Name	JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN
Plan identification number	003

JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN Benefits

401k Plan Type	Defined Benefit Pension
Plan Features/Benefits	Benefits are primarily pay related Money purchase (other than target benefit) 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

JACK R. ACHEATEL, D.D.S., INC. has sponsored the creation of one or more 401k plans.

Company Name: JACK R. ACHEATEL, D.D.S., INC.

Employer identification number (EIN): 953168947

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2013-01-01
003 2012-01-01 JACK R ACHEATEL DDS JACK R ACHEATEL DDS 2013-10-02
003 2011-01-01 JACK R ACHEATEL DDS JACK R ACHEATEL DDS 2012-10-01
003 2009-01-01 JACK R. ACHEATEL, D.D.S. JACK R. ACHEATEL, D.D.S. 2010-10-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
003	2013-01-01
003	2012-01-01	JACK R ACHEATEL DDS	JACK R ACHEATEL DDS	2013-10-02
003	2011-01-01	JACK R ACHEATEL DDS	JACK R ACHEATEL DDS	2012-10-01
003	2009-01-01	JACK R. ACHEATEL, D.D.S.	JACK R. ACHEATEL, D.D.S.	2010-10-13

Plan Statistics for JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN

401k plan membership statisitcs for JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN

Measure Date Value
2013: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1
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 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 1
Number of participants with account balances 2013-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1
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 3
Total of all active and inactive participants 2012-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 3
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 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2
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 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2013: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1
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	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	1
Number of participants with account balances	2013-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1
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	3
Total of all active and inactive participants	2012-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3
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	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2
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	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN

Measure	Date	Value
2013 : JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$198,063
Expenses. Total of all expenses incurred	2013-12-31	$160,754
Benefits paid (including direct rollovers)	2013-12-31	$160,754
Total plan assets at end of year	2013-12-31	$2,883,094
Total plan assets at beginning of year	2013-12-31	$2,845,785
Value of fidelity bond covering the plan	2013-12-31	$30,000
Assets. Value of tangible personal property	2013-12-31	$15,500
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$198,063
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$37,309
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,883,094
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,845,785
Assets. Value of real-estate (other than employer real property)	2013-12-31	$120,000
Total contributions received or receivable from employer(s)	2013-12-31	$0
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	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
2012 : JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN 2012 401k financial data
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$581,304
Expenses. Total of all expenses incurred	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$2,845,785
Total plan assets at beginning of year	2012-12-31	$2,264,481
Value of fidelity bond covering the plan	2012-12-31	$30,000
Assets. Value of tangible personal property	2012-12-31	$15,500
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$120,304
Net income (gross income less expenses)	2012-12-31	$581,304
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,845,785
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,264,481
Assets. Value of real-estate (other than employer real property)	2012-12-31	$120,000
Total contributions received or receivable from employer(s)	2012-12-31	$461,000
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : JACK R. ACHEATEL, D.D.S., INC., RETIREMENT 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	$186,076
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	$2,264,481
Total plan assets at beginning of year	2011-12-31	$2,078,405
Value of fidelity bond covering the plan	2011-12-31	$30,000
Assets. Value of tangible personal property	2011-12-31	$15,500
Total contributions received or receivable from participants	2011-12-31	$0
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	$63,576
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$186,076
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,264,481
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,078,405
Assets. Value of real-estate (other than employer real property)	2011-12-31	$120,000
Total contributions received or receivable from employer(s)	2011-12-31	$122,500
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	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : JACK R. ACHEATEL, D.D.S., INC., RETIREMENT 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	$257,889
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	$2,078,405
Total plan assets at beginning of year	2010-12-31	$1,820,516
Value of fidelity bond covering the plan	2010-12-31	$30,000
Assets. Value of tangible personal property	2010-12-31	$15,500
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	$176,389
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$257,889
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,078,405
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,820,516
Assets. Value of real-estate (other than employer real property)	2010-12-31	$120,000
Total contributions received or receivable from employer(s)	2010-12-31	$81,500
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 : JACK R. ACHEATEL, D.D.S., INC., RETIREMENT 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 JACK R. ACHEATEL, D.D.S., INC., RETIREMENT PLAN

2013: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT 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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT 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: JACK R. ACHEATEL, D.D.S., INC., RETIREMENT 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:	JACK R. ACHEATEL, D.D.S., INC.
Employer identification number (EIN):	953168947
NAIC Classification:	621210
NAIC Description:	Offices of Dentists