401k Plan data: MATTHEW R. LARK DDS PC, INC 401(K) PLAN plan

MATTHEW R. LARK DDS PC, INC 401(K) PLAN 401k Plan overview

Plan Name	MATTHEW R. LARK DDS PC, INC 401(K) PLAN
Plan identification number	002

MATTHEW R. LARK DDS PC, INC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
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.
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

MATTHEW R. LARK DDS PC, INC has sponsored the creation of one or more 401k plans.

Company Name: MATTHEW R. LARK DDS PC, INC

Employer identification number (EIN): 341682325

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MATTHEW R. LARK DDS PC, INC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2017-01-01 BRIGID MURPHY-LARK 2018-04-30 BRIGID MURPHY-LARK 2018-04-30
002 2016-01-01 BRIGID MURPHY-LARK 2017-07-25
002 2015-01-01 BRIGID MURPHY-LARK 2016-07-29
002 2014-01-01 BRIGID MURPHY-LARK 2015-10-15
002 2013-01-01 BRIGID MURPHY-LARK 2015-10-14
002 2012-01-01 BRIGID MURPHY-LARK 2013-10-10
002 2011-01-01 BRIGID MURPHY-LARK 2012-10-15 BRIGID MURPHY-LARK 2012-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2017-01-01	BRIGID MURPHY-LARK	2018-04-30	BRIGID MURPHY-LARK	2018-04-30
002	2016-01-01	BRIGID MURPHY-LARK	2017-07-25
002	2015-01-01	BRIGID MURPHY-LARK	2016-07-29
002	2014-01-01	BRIGID MURPHY-LARK	2015-10-15
002	2013-01-01	BRIGID MURPHY-LARK	2015-10-14
002	2012-01-01	BRIGID MURPHY-LARK	2013-10-10
002	2011-01-01	BRIGID MURPHY-LARK	2012-10-15	BRIGID MURPHY-LARK	2012-10-15

Financial Data on MATTHEW R. LARK DDS PC, INC 401(K) PLAN

Measure	Date	Value
2010 : MATTHEW R. LARK DDS PC, INC 401(K) PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$179,028
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	$869,542
Total plan assets at beginning of year	2010-12-31	$690,514
Value of fidelity bond covering the plan	2010-12-31	$750,000
Total contributions received or receivable from participants	2010-12-31	$52,866
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$11,554
Other income received	2010-12-31	$77,515
Net income (gross income less expenses)	2010-12-31	$179,028
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$869,542
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$690,514
Assets. Value of participant loans	2010-12-31	$1,758
Total contributions received or receivable from employer(s)	2010-12-31	$37,093
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-819725

Policy instance

Insurance contract or identification number	GA-819725
Number of Individuals Covered	11
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,928
Total amount of fees paid to insurance company	USD $331
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,928
Insurance broker organization code?	3
Amount paid for insurance broker fees	331
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker name	MERRILL LYNCH PIERCE FENNER SMITH I

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Company Name:	MATTHEW R. LARK DDS PC, INC
Employer identification number (EIN):	341682325
NAIC Classification:	621210
NAIC Description:	Offices of Dentists