401k Plan data: LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN plan

LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 401k Plan overview

Plan Name	LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN
Plan identification number	005

LAKE REGION MEDICAL GROUP, P.A. 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.
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

LAKE REGION MEDICAL GROUP, P.A. has sponsored the creation of one or more 401k plans.

Company Name: LAKE REGION MEDICAL GROUP, P.A.

Employer identification number (EIN): 272451481

NAIC Classification: 621112
NAIC Description: Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
005 2022-10-01
005 2021-10-01 TREVOR GERVAIS 2023-04-18 TREVOR GERVAIS 2023-04-18
005 2020-10-01 MATTHEW LEE 2022-04-26 MATTHEW LEE 2022-04-26
005 2019-10-01 LUCAS DRAXTEN 2021-04-20 LUCAS DRAXTEN 2021-04-20
005 2018-10-01 LUCAS DRAXTEN 2020-03-10 LUCAS DRAXTEN 2020-03-10
005 2017-10-01 LUKE DRAXTEN 2019-01-10 LUKE DRAXTEN 2019-01-10
005 2016-10-01 LUKE DRAXTEN 2018-03-27 LUKE DRAXTEN 2018-03-27
005 2015-10-01 JON GALE 2017-04-25 JON GALE 2017-04-25
005 2014-10-01 JON GALE 2016-02-13 JON GALE 2016-02-13
005 2013-10-01 TIMOTHY BERGIN 2015-02-14 TIMOTHY BERGIN 2015-02-14
005 2012-10-01 TIMOTHY BERGIN 2014-03-14 TIMOTHY BERGIN 2014-03-14
005 2011-10-01 TIMOTHY BERGIN CPA TIMOTHY BERGIN CPA 2013-04-30
005 2010-10-01 TIMOTHY BERGIN CPA TIMOTHY BERGIN CPA 2012-07-13
005 2010-05-01 JAY ROSS JAY ROSS 2011-07-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
005	2022-10-01
005	2021-10-01	TREVOR GERVAIS	2023-04-18	TREVOR GERVAIS	2023-04-18
005	2020-10-01	MATTHEW LEE	2022-04-26	MATTHEW LEE	2022-04-26
005	2019-10-01	LUCAS DRAXTEN	2021-04-20	LUCAS DRAXTEN	2021-04-20
005	2018-10-01	LUCAS DRAXTEN	2020-03-10	LUCAS DRAXTEN	2020-03-10
005	2017-10-01	LUKE DRAXTEN	2019-01-10	LUKE DRAXTEN	2019-01-10
005	2016-10-01	LUKE DRAXTEN	2018-03-27	LUKE DRAXTEN	2018-03-27
005	2015-10-01	JON GALE	2017-04-25	JON GALE	2017-04-25
005	2014-10-01	JON GALE	2016-02-13	JON GALE	2016-02-13
005	2013-10-01	TIMOTHY BERGIN	2015-02-14	TIMOTHY BERGIN	2015-02-14
005	2012-10-01	TIMOTHY BERGIN	2014-03-14	TIMOTHY BERGIN	2014-03-14
005	2011-10-01	TIMOTHY BERGIN CPA		TIMOTHY BERGIN CPA	2013-04-30
005	2010-10-01	TIMOTHY BERGIN CPA		TIMOTHY BERGIN CPA	2012-07-13
005	2010-05-01	JAY ROSS		JAY ROSS	2011-07-15

Plan Statistics for LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN

401k plan membership statisitcs for LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN

Measure Date Value
2011: LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 146
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 56
Number of other retired or separated participants entitled to future benefits 2011-10-01 24
Total of all active and inactive participants 2011-10-01 80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-10-01 0
Total participants 2011-10-01 80
Number of participants with account balances 2011-10-01 79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 0
2010: LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-10-01 142
Total number of active participants reported on line 7a of the Form 5500 2010-10-01 44
Number of other retired or separated participants entitled to future benefits 2010-10-01 101
Total of all active and inactive participants 2010-10-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-10-01 0
Total participants 2010-10-01 145
Number of participants with account balances 2010-10-01 144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-10-01 0
Total participants, beginning-of-year 2010-05-01 301
Total number of active participants reported on line 7a of the Form 5500 2010-05-01 49
Number of retired or separated participants receiving benefits 2010-05-01 108
Number of other retired or separated participants entitled to future benefits 2010-05-01 0
Total of all active and inactive participants 2010-05-01 157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-05-01 0
Total participants 2010-05-01 157
Number of participants with account balances 2010-05-01 155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-05-01 0

Measure	Date	Value
2011: LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	146
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	56
Number of other retired or separated participants entitled to future benefits	2011-10-01	24
Total of all active and inactive participants	2011-10-01	80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-10-01	0
Total participants	2011-10-01	80
Number of participants with account balances	2011-10-01	79
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	0
2010: LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-10-01	142
Total number of active participants reported on line 7a of the Form 5500	2010-10-01	44
Number of other retired or separated participants entitled to future benefits	2010-10-01	101
Total of all active and inactive participants	2010-10-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-10-01	0
Total participants	2010-10-01	145
Number of participants with account balances	2010-10-01	144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-10-01	0
Total participants, beginning-of-year	2010-05-01	301
Total number of active participants reported on line 7a of the Form 5500	2010-05-01	49
Number of retired or separated participants receiving benefits	2010-05-01	108
Number of other retired or separated participants entitled to future benefits	2010-05-01	0
Total of all active and inactive participants	2010-05-01	157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-05-01	0
Total participants	2010-05-01	157
Number of participants with account balances	2010-05-01	155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-05-01	0

Financial Data on LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN

Measure	Date	Value
2012 : LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-09-30	$97,795
Total unrealized appreciation/depreciation of assets	2012-09-30	$97,795
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$2,463
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$3,062
Total income from all sources (including contributions)	2012-09-30	$4,377,710
Total of all expenses incurred	2012-09-30	$1,617,671
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-09-30	$1,596,758
Value of total corrective distributions	2012-09-30	$441
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-09-30	$1,593,830
Value of total assets at end of year	2012-09-30	$22,294,045
Value of total assets at beginning of year	2012-09-30	$19,534,605
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-09-30	$20,472
Total interest from all sources	2012-09-30	$21,873
Total dividends received (eg from common stock, registered investment company shares)	2012-09-30	$514,467
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-09-30	$514,467
Was this plan covered by a fidelity bond	2012-09-30	Yes
Value of fidelity bond cover	2012-09-30	$500,000
If this is an individual account plan, was there a blackout period	2012-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2012-09-30	No
Contributions received from participants	2012-09-30	$660,574
Participant contributions at end of year	2012-09-30	$1,769
Participant contributions at beginning of year	2012-09-30	$17,044
Participant contributions at end of year	2012-09-30	$62,171
Participant contributions at beginning of year	2012-09-30	$42,900
Assets. Other investments not covered elsewhere at end of year	2012-09-30	$1,895,287
Assets. Other investments not covered elsewhere at beginning of year	2012-09-30	$422,659
Income. Received or receivable in cash from other sources (including rollovers)	2012-09-30	$1,347
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-09-30	$1,125
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-09-30	$2,463
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-09-30	$3,062
Other income not declared elsewhere	2012-09-30	$35,195
Administrative expenses (other) incurred	2012-09-30	$18,261
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-09-30	No
Value of net income/loss	2012-09-30	$2,760,039
Value of net assets at end of year (total assets less liabilities)	2012-09-30	$22,291,582
Value of net assets at beginning of year (total assets less liabilities)	2012-09-30	$19,531,543
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-09-30	No
Were any leases to which the plan was party in default or uncollectible	2012-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-09-30	$16,363,332
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-09-30	$17,991,689
Interest on participant loans	2012-09-30	$380
Interest earned on other investments	2012-09-30	$21,456
Value of interest in common/collective trusts at beginning of year	2012-09-30	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-09-30	$37
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-09-30	$3,329,260
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-09-30	$424,046
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-09-30	$2,113,210
Net investment gain or loss from common/collective trusts	2012-09-30	$1,340
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-09-30	No
Was there a failure to transmit to the plan any participant contributions	2012-09-30	No
Has the plan failed to provide any benefit when due under the plan	2012-09-30	No
Contributions received in cash from employer	2012-09-30	$931,909
Employer contributions (assets) at end of year	2012-09-30	$642,226
Employer contributions (assets) at beginning of year	2012-09-30	$636,267
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-09-30	$1,595,633
Contract administrator fees	2012-09-30	$2,211
Did the plan have assets held for investment	2012-09-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-09-30	Disclaimer
Accountancy firm name	2012-09-30	CONWAY, DEUTH & SCHMIESING, PLLP
Accountancy firm EIN	2012-09-30	411539592
2011 : LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-09-30	$446,290
Total unrealized appreciation/depreciation of assets	2011-09-30	$446,290
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$3,062
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$20,740
Total income from all sources (including contributions)	2011-09-30	$1,575,464
Total loss/gain on sale of assets	2011-09-30	$0
Total of all expenses incurred	2011-09-30	$8,938,230
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-09-30	$8,904,621
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-09-30	$1,566,399
Value of total assets at end of year	2011-09-30	$19,534,605
Value of total assets at beginning of year	2011-09-30	$26,915,049
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-09-30	$33,609
Total interest from all sources	2011-09-30	$1,660
Total dividends received (eg from common stock, registered investment company shares)	2011-09-30	$483,695
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-09-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-09-30	$483,695
Administrative expenses professional fees incurred	2011-09-30	$0
Was this plan covered by a fidelity bond	2011-09-30	Yes
Value of fidelity bond cover	2011-09-30	$500,000
If this is an individual account plan, was there a blackout period	2011-09-30	Yes
Were there any nonexempt tranactions with any party-in-interest	2011-09-30	No
Contributions received from participants	2011-09-30	$544,230
Participant contributions at end of year	2011-09-30	$17,044
Participant contributions at beginning of year	2011-09-30	$73,857
Participant contributions at end of year	2011-09-30	$42,900
Participant contributions at beginning of year	2011-09-30	$40,771
Assets. Other investments not covered elsewhere at end of year	2011-09-30	$422,659
Assets. Other investments not covered elsewhere at beginning of year	2011-09-30	$2,553,013
Income. Received or receivable in cash from other sources (including rollovers)	2011-09-30	$127,889
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-09-30	$43,124
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-09-30	$3,062
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-09-30	$20,740
Other income not declared elsewhere	2011-09-30	$17,676
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-09-30	No
Value of net income/loss	2011-09-30	$-7,362,766
Value of net assets at end of year (total assets less liabilities)	2011-09-30	$19,531,543
Value of net assets at beginning of year (total assets less liabilities)	2011-09-30	$26,894,309
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-09-30	No
Were any leases to which the plan was party in default or uncollectible	2011-09-30	No
Investment advisory and management fees	2011-09-30	$20,999
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-09-30	$17,991,689
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-09-30	$11,770,795
Interest on participant loans	2011-09-30	$1,658
Value of interest in common/collective trusts at end of year	2011-09-30	$0
Value of interest in common/collective trusts at beginning of year	2011-09-30	$5,021,991
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-09-30	$516,619
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-09-30	$516,619
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-09-30	$2
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-09-30	$424,046
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-09-30	$0
Asset value of US Government securities at beginning of year	2011-09-30	$1,587,569
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-09-30	$-1,014,526
Net investment gain or loss from common/collective trusts	2011-09-30	$74,270
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-09-30	No
Was there a failure to transmit to the plan any participant contributions	2011-09-30	No
Has the plan failed to provide any benefit when due under the plan	2011-09-30	No
Contributions received in cash from employer	2011-09-30	$894,280
Employer contributions (assets) at end of year	2011-09-30	$636,267
Employer contributions (assets) at beginning of year	2011-09-30	$950,218
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-09-30	$8,904,621
Asset. Corporate debt instrument preferred debt at beginning of year	2011-09-30	$940,428
Contract administrator fees	2011-09-30	$12,610
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-09-30	Yes
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-09-30	$3,416,664
Did the plan have assets held for investment	2011-09-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-09-30	Disclaimer
Accountancy firm name	2011-09-30	CONWAY, DEUTH & SCHMIESING, PLLP
Accountancy firm EIN	2011-09-30	411539592
2010 : LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-09-30	$-38,023
Total unrealized appreciation/depreciation of assets	2010-09-30	$-38,023
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-09-30	$20,740
Total income from all sources (including contributions)	2010-09-30	$317,154
Total of all expenses incurred	2010-09-30	$10,349,273
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-09-30	$10,317,898
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-09-30	$558,878
Value of total assets at end of year	2010-09-30	$27,144,544
Value of total assets at beginning of year	2010-09-30	$37,155,923
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-09-30	$31,375
Total interest from all sources	2010-09-30	$13,996
Total dividends received (eg from common stock, registered investment company shares)	2010-09-30	$91,074
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-09-30	No
Was this plan covered by a fidelity bond	2010-09-30	Yes
Value of fidelity bond cover	2010-09-30	$500,000
If this is an individual account plan, was there a blackout period	2010-09-30	No
Were there any nonexempt tranactions with any party-in-interest	2010-09-30	No
Contributions received from participants	2010-09-30	$221,354
Participant contributions at end of year	2010-09-30	$314,185
Participant contributions at beginning of year	2010-09-30	$417,263
Participant contributions at end of year	2010-09-30	$40,771
Participant contributions at beginning of year	2010-09-30	$63,666
Assets. Other investments not covered elsewhere at end of year	2010-09-30	$394,149
Assets. Other investments not covered elsewhere at beginning of year	2010-09-30	$2,443,574
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-09-30	$19,631
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-09-30	$64,141
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-09-30	$20,740
Total non interest bearing cash at end of year	2010-09-30	$1,110
Total non interest bearing cash at beginning of year	2010-09-30	$9,269
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-09-30	No
Value of net income/loss	2010-09-30	$-10,032,119
Value of net assets at end of year (total assets less liabilities)	2010-09-30	$27,123,804
Value of net assets at beginning of year (total assets less liabilities)	2010-09-30	$37,155,923
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-09-30	No
Were any leases to which the plan was party in default or uncollectible	2010-09-30	No
Investment advisory and management fees	2010-09-30	$12,210
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-09-30	$11,508,183
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-09-30	$17,388,024
Value of interest in pooled separate accounts at end of year	2010-09-30	$6,554,492
Interest on participant loans	2010-09-30	$3,823
Interest earned on other investments	2010-09-30	$10,165
Value of interest in common/collective trusts at end of year	2010-09-30	$5,021,991
Value of interest in common/collective trusts at beginning of year	2010-09-30	$8,424,483
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-09-30	$191,784
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-09-30	$1,147,137
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-09-30	$1,147,137
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-09-30	$8
Expenses. Payments to insurance carriers foe the provision of benefits	2010-09-30	$3,645
Asset value of US Government securities at beginning of year	2010-09-30	$1,590,062
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-09-30	$-329,765
Net investment gain/loss from pooled separate accounts	2010-09-30	$-35,751
Net investment gain or loss from common/collective trusts	2010-09-30	$56,745
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-09-30	No
Was there a failure to transmit to the plan any participant contributions	2010-09-30	No
Has the plan failed to provide any benefit when due under the plan	2010-09-30	No
Contributions received in cash from employer	2010-09-30	$337,524
Employer contributions (assets) at end of year	2010-09-30	$950,218
Employer contributions (assets) at beginning of year	2010-09-30	$721,695
Income. Dividends from common stock	2010-09-30	$91,074
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-09-30	$10,314,253
Asset. Corporate debt instrument preferred debt at beginning of year	2010-09-30	$915,061
Contract administrator fees	2010-09-30	$19,165
Assets. Corporate common stocks other than exployer securities at end of year	2010-09-30	$2,148,030
Assets. Corporate common stocks other than exployer securities at beginning of year	2010-09-30	$3,971,548
Did the plan have assets held for investment	2010-09-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2010-09-30	Disclaimer

Form 5500 Responses for LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN

2011: LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	Yes
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan funding arrangement – Trust	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement - Trust	Yes
2010: LAKE REGION MEDICAL GROUP, P.A. 401(K) & PROFIT SHARING PLAN 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	Submission has been amended	Yes
2010-10-01	This submission is the final filing	No
2010-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-10-01	Plan is a collectively bargained plan	No
2010-10-01	Plan funding arrangement – Insurance	Yes
2010-10-01	Plan funding arrangement – Trust	Yes
2010-10-01	Plan benefit arrangement – Insurance	Yes
2010-10-01	Plan benefit arrangement - Trust	Yes
2010-05-01	Type of plan entity	Single employer plan
2010-05-01	Submission has been amended	No
2010-05-01	This submission is the final filing	No
2010-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2010-05-01	Plan is a collectively bargained plan	No
2010-05-01	Plan funding arrangement – Insurance	Yes
2010-05-01	Plan funding arrangement – Trust	Yes
2010-05-01	Plan benefit arrangement – Insurance	Yes
2010-05-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

332194-01

Policy instance

Insurance contract or identification number	332194-01
Number of Individuals Covered	46
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $7,203
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

13908

Policy instance

Insurance contract or identification number	13908
Number of Individuals Covered	4
Insurance policy start date	2021-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

332194-01

Policy instance

Insurance contract or identification number	332194-01
Number of Individuals Covered	32
Insurance policy start date	2010-11-15
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $540
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
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

13908

Policy instance

Insurance contract or identification number	13908
Number of Individuals Covered	4
Insurance policy start date	2020-05-01
Insurance policy end date	2011-04-30
Life Insurance Welfare Benefit	Yes
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

13908

Policy instance

Insurance contract or identification number	13908
Number of Individuals Covered	4
Insurance policy start date	2010-05-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	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:	LAKE REGION MEDICAL GROUP, P.A.
Employer identification number (EIN):	272451481
NAIC Classification:	621112
NAIC Description:	Offices of Physicians, Mental Health Specialists