401k Plan data: ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN plan

ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN 401k Plan overview

Plan Name	ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN
Plan identification number	503

ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC has sponsored the creation of one or more 401k plans.

Company Name: ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC

Employer identification number (EIN): 260152289

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2012-03-01 PAUL BARNES PAUL BARNES 2013-11-13
503 2012-03-01 MATTHEW MCCORMLEY
503 2012-02-01 PAUL BARNES PAUL BARNES 2013-10-18
503 2011-02-01 PAUL BARNES PAUL BARNES 2013-10-10

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2012-03-01	PAUL BARNES	PAUL BARNES	2013-11-13
503	2012-03-01	MATTHEW MCCORMLEY
503	2012-02-01	PAUL BARNES	PAUL BARNES	2013-10-18
503	2011-02-01	PAUL BARNES	PAUL BARNES	2013-10-10

Plan Statistics for ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN

401k plan membership statisitcs for ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN

Measure Date Value
2012: ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-03-01 256
Total number of active participants reported on line 7a of the Form 5500 2012-03-01 301
Total of all active and inactive participants 2012-03-01 301
Total participants 2012-03-01 301
Total participants, beginning-of-year 2012-02-01 255
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 256
Total of all active and inactive participants 2012-02-01 256
2011: ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-02-01 216
Total number of active participants reported on line 7a of the Form 5500 2011-02-01 255
Total of all active and inactive participants 2011-02-01 255

Measure	Date	Value
2012: ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-03-01	256
Total number of active participants reported on line 7a of the Form 5500	2012-03-01	301
Total of all active and inactive participants	2012-03-01	301
Total participants	2012-03-01	301
Total participants, beginning-of-year	2012-02-01	255
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	256
Total of all active and inactive participants	2012-02-01	256
2011: ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-02-01	216
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	255
Total of all active and inactive participants	2011-02-01	255

Form 5500 Responses for ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN

2012: ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN 2012 form 5500 responses
2012-03-01	Type of plan entity	Single employer plan
2012-03-01	Submission has been amended	No
2012-03-01	This submission is the final filing	No
2012-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-03-01	Plan is a collectively bargained plan	No
2012-03-01	Plan funding arrangement – Insurance	Yes
2012-03-01	Plan benefit arrangement – Insurance	Yes
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	Submission has been amended	No
2012-02-01	This submission is the final filing	No
2012-02-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-02-01	Plan is a collectively bargained plan	No
2012-02-01	Plan funding arrangement – Insurance	Yes
2012-02-01	Plan benefit arrangement – Insurance	Yes
2011: ORTHOPEDIC SPECIALISTS OF NORTH AMERICA PLLC DENTAL PLAN 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	First time form 5500 has been submitted	Yes
2011-02-01	Submission has been amended	No
2011-02-01	This submission is the final filing	No
2011-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-02-01	Plan is a collectively bargained plan	No
2011-02-01	Plan funding arrangement – Insurance	Yes
2011-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05760374

Policy instance

Insurance contract or identification number	KM05760374
Number of Individuals Covered	899
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $17,574
Total amount of fees paid to insurance company	USD $1,639
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	Yes
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 $206,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,330
Amount paid for insurance broker fees	1189
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	BROWN & BROWN INSURANCE OF ARIZONA

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05760374

Policy instance

Insurance contract or identification number	KM05760374
Number of Individuals Covered	941
Insurance policy start date	2012-02-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $476
Total amount of fees paid to insurance company	USD $31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,648
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $476
Amount paid for insurance broker fees	31
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOVITT TOUCHE INC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05760374

Policy instance

Insurance contract or identification number	KM05760374
Number of Individuals Covered	947
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $13,020
Total amount of fees paid to insurance company	USD $3,482
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $161,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ORTHOPEDIC SPECIALISTS OF NORTH AMERICA, PLLC
Employer identification number (EIN):	260152289
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)