401k Plan data: DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN plan

DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN
Plan identification number	002

DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
Plan covering Self-Employed individuals.
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.
Life insurance

401k Sponsoring company profile

DR. THOMAS R. MILLER DENTISTRY has sponsored the creation of one or more 401k plans.

Company Name: DR. THOMAS R. MILLER DENTISTRY

Employer identification number (EIN): 141566503

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01 THOMAS MILLER 2020-06-29 THOMAS MILLER 2020-06-29
002 2018-01-01 DENISE MILLER 2019-10-01 DENISE MILLER 2019-10-01
002 2017-01-01 THOMAS MILLER 2018-08-27 THOMAS MILLER 2018-08-27
002 2016-01-01 THOMAS MILLER 2017-07-25 THOMAS MILLER 2017-07-25
002 2015-01-01 THOMAS MILLER 2016-07-26 THOMAS MILLER 2016-07-26
002 2014-01-01 THOMAS MILLER 2015-07-28 THOMAS MILLER 2015-07-28
002 2013-01-01 THOMAS MILLER 2014-10-13 THOMAS MILLER 2014-10-13
002 2012-01-01 VALERI R. DEDICH, ERPA, QPA, QKA 2013-10-09
002 2011-01-01 THOMAS D. MILLER
002 2010-01-01 THOMAS MILLER
002 2009-01-01 THOMAS MILLER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2019-01-01	THOMAS MILLER	2020-06-29	THOMAS MILLER	2020-06-29
002	2018-01-01	DENISE MILLER	2019-10-01	DENISE MILLER	2019-10-01
002	2017-01-01	THOMAS MILLER	2018-08-27	THOMAS MILLER	2018-08-27
002	2016-01-01	THOMAS MILLER	2017-07-25	THOMAS MILLER	2017-07-25
002	2015-01-01	THOMAS MILLER	2016-07-26	THOMAS MILLER	2016-07-26
002	2014-01-01	THOMAS MILLER	2015-07-28	THOMAS MILLER	2015-07-28
002	2013-01-01	THOMAS MILLER	2014-10-13	THOMAS MILLER	2014-10-13
002	2012-01-01	VALERI R. DEDICH, ERPA, QPA, QKA	2013-10-09
002	2011-01-01	THOMAS D. MILLER
002	2010-01-01	THOMAS MILLER
002	2009-01-01	THOMAS MILLER

Plan Statistics for DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN

Measure Date Value
2011: DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 6
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 1
Total of all active and inactive participants 2011-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 7
Number of participants with account balances 2011-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 8
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 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 8
Number of participants with account balances 2010-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 7
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 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 8
Number of participants with account balances 2009-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	6
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	1
Total of all active and inactive participants	2011-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	7
Number of participants with account balances	2011-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	8
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	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	8
Number of participants with account balances	2010-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	7
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	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	8
Number of participants with account balances	2009-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2011 : DR. THOMAS R. MILLER DENTISTRY 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	$-27,784
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	$1,803,817
Total plan assets at beginning of year	2011-12-31	$1,831,601
Value of fidelity bond covering the plan	2011-12-31	$195,000
Assets. Value of tangible personal property	2011-12-31	$0
Total contributions received or receivable from participants	2011-12-31	$59,674
Assets. Value of loans (other than to 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	$-102,653
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-27,784
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,803,817
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,831,601
Assets. Value of participant loans	2011-12-31	$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	2011-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2011-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$0
Assets. Value of real-estate (other than employer real property)	2011-12-31	$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	2011-12-31	$0
Assets. Value of employer securities	2011-12-31	$0
Assets. Value of employer real property	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$15,195
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
2010 : DR. THOMAS R. MILLER DENTISTRY 401(K) 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	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$270,290
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	$1,831,601
Total plan assets at beginning of year	2010-12-31	$1,561,311
Value of fidelity bond covering the plan	2010-12-31	$250,000
Assets. Value of tangible personal property	2010-12-31	$0
Total contributions received or receivable from participants	2010-12-31	$69,941
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	$184,723
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$270,290
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,831,601
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,561,311
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	$15,626
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

Form 5500 Responses for DR. THOMAS R. MILLER DENTISTRY 401(K) PROFIT SHARING PLAN

2011: DR. THOMAS R. MILLER DENTISTRY 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: DR. THOMAS R. MILLER DENTISTRY 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: DR. THOMAS R. MILLER DENTISTRY 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

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

33487

Policy instance

Insurance contract or identification number	33487
Number of Individuals Covered	3
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )

Policy contract number

33487

Policy instance

Insurance contract or identification number	33487
Number of Individuals Covered	3
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	DR. THOMAS R. MILLER DENTISTRY
Employer identification number (EIN):	141566503
NAIC Classification:	621210
NAIC Description:	Offices of Dentists