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| Plan Name | JAMES W ORPHAN PROFIT SHARING PLAN AND TRUST |
| Plan identification number | 001 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
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| Company Name: | WALPOLE CHIROPRACTIC AND DIAGNOSTIC CENTER |
| Employer identification number (EIN): | 042882143 |
| NAIC Classification: | 621310 |
| NAIC Description: | Offices of Chiropractors |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 001 | 2015-01-01 | JAMES ORPHAN | 2015-08-19 | ||
| 001 | 2014-01-01 | JAMES ORPHAN | 2015-06-17 | ||
| 001 | 2013-01-01 | JAMES ORPHAN | 2014-05-12 | ||
| 001 | 2012-01-01 | JAMES ORPHAN | 2013-05-29 | ||
| 001 | 2011-01-01 | JAMES ORPHAN | 2012-07-27 | ||
| 001 | 2010-01-01 | JAMES W ORPHAN | |||
| 001 | 2009-01-01 | JAMES W ORPHAN |
| Measure | Date | Value |
|---|---|---|
| 2010: JAMES W ORPHAN PROFIT SHARING PLAN AND TRUST 2010 401k membership | ||
| Total participants, beginning-of-year | 2010-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 2 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 2 |
| Number of participants with account balances | 2010-01-01 | 2 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-01-01 | 0 |
| 2009: JAMES W ORPHAN PROFIT SHARING PLAN AND TRUST 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 2 |
| 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 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 2 |
| Number of participants with account balances | 2009-01-01 | 2 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 0 |
| Measure | Date | Value |
|---|---|---|
| 2010 : JAMES W ORPHAN PROFIT SHARING PLAN AND TRUST 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 | $32,243 |
| 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 | $230,871 |
| Total plan assets at beginning of year | 2010-12-31 | $198,628 |
| Value of fidelity bond covering the plan | 2010-12-31 | $20,000 |
| Assets. Value of tangible personal property | 2010-12-31 | $0 |
| Total contributions received or receivable from participants | 2010-12-31 | $0 |
| Assets. Value of loans (other than to 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 | $12,243 |
| Noncash contributions received | 2010-12-31 | $0 |
| Net income (gross income less expenses) | 2010-12-31 | $32,243 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $230,871 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $198,628 |
| Assets. Value of participant loans | 2010-12-31 | $0 |
| Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year | 2010-12-31 | $0 |
| Value of leases to which the plan was a party in default or classified as uncollectible during the plan year | 2010-12-31 | $0 |
| Assets. Value of assets in partnership/joint-venture interests | 2010-12-31 | $0 |
| Assets. Value of real-estate (other than employer real property) | 2010-12-31 | $0 |
| Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102 | 2010-12-31 | $0 |
| Assets. Value of employer securities | 2010-12-31 | $0 |
| Assets. Value of employer real property | 2010-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $20,000 |
| 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 |
| 2010: JAMES W ORPHAN PROFIT SHARING PLAN AND TRUST 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: JAMES W ORPHAN PROFIT SHARING PLAN AND TRUST 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 |
| LIFE INSURANCE COMPANY OF THE SOUTHWEST (National Association of Insurance Commissioners NAIC id number: 65528 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 32838 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66680 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0328380 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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