401k Plan data: WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN plan

WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN
Plan identification number	001

WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Money purchase (other than target benefit)
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.
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

WESTERN CAROLINA UROLOGICAL has sponsored the creation of one or more 401k plans.

Company Name: WESTERN CAROLINA UROLOGICAL

Employer identification number (EIN): 562062493

NAIC Classification: 621399
NAIC Description: Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 D. SCOTT DONALDSON 2013-10-03
001 2011-01-01 D. SCOTT DONALDSON 2012-07-26
001 2010-01-01 DAVID SCOTT DONALDSON
001 2008-01-01 DAVID SCOTT DONALDSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2012-01-01	D. SCOTT DONALDSON	2013-10-03
001	2011-01-01	D. SCOTT DONALDSON	2012-07-26
001	2010-01-01	DAVID SCOTT DONALDSON
001	2008-01-01	DAVID SCOTT DONALDSON

Plan Statistics for WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN

Measure Date Value
2010: WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 0
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 14
Total of all active and inactive participants 2010-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 14
Number of participants with account balances 2010-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2008: WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 11
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 3
Total of all active and inactive participants 2008-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2008-01-01 0
Total participants 2008-01-01 14
Number of participants with account balances 2008-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2008-01-01 2

Measure	Date	Value
2010: WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	0
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	14
Total of all active and inactive participants	2010-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	14
Number of participants with account balances	2010-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2008: WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	11
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	3
Total of all active and inactive participants	2008-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2008-01-01	0
Total participants	2008-01-01	14
Number of participants with account balances	2008-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2008-01-01	2

Financial Data on WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2010 : WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 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	$19,402
Expenses. Total of all expenses incurred	2010-12-31	$15,317
Benefits paid (including direct rollovers)	2010-12-31	$15,317
Total plan assets at end of year	2010-12-31	$189,963
Total plan assets at beginning of year	2010-12-31	$185,878
Value of fidelity bond covering the plan	2010-12-31	$80,000
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	$19,402
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$4,085
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$189,963
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$185,878
Assets. Value of participant loans	2010-12-31	$500
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	$0
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
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2010-12-31	0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN 2009 401k financial data
Transfers to/from the plan	2009-12-31	$0
Total plan liabilities at end of year	2009-12-31	$0
Total plan liabilities at beginning of year	2009-12-31	$0
Total income from all sources	2009-12-31	$44,162
Expenses. Total of all expenses incurred	2009-12-31	$7,464
Benefits paid (including direct rollovers)	2009-12-31	$7,464
Total plan assets at end of year	2009-12-31	$185,878
Total plan assets at beginning of year	2009-12-31	$149,180
Value of fidelity bond covering the plan	2009-12-31	$0
Assets. Value of tangible personal property	2009-12-31	$0
Total contributions received or receivable from participants	2009-12-31	$10,040
Assets. Value of loans (other than to participants)	2009-12-31	$0
Expenses. Other expenses not covered elsewhere	2009-12-31	$0
Contributions received from other sources (not participants or employers)	2009-12-31	$0
Other income received	2009-12-31	$33,557
Noncash contributions received	2009-12-31	$0
Net income (gross income less expenses)	2009-12-31	$36,698
Net plan assets at end of year (total assets less liabilities)	2009-12-31	$185,878
Net plan assets at beginning of year (total assets less liabilities)	2009-12-31	$149,180
Assets. Value of participant loans	2009-12-31	$7,825
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	2009-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2009-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2009-12-31	$0
Assets. Value of real-estate (other than employer real property)	2009-12-31	$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	2009-12-31	$0
Assets. Value of employer securities	2009-12-31	$0
Assets. Value of employer real property	2009-12-31	$0
Total contributions received or receivable from employer(s)	2009-12-31	$565
Value of certain deemed distributions of participant loans	2009-12-31	$0
Value of corrective distributions	2009-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2009-12-31	$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2009-12-31	0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0
2008 : WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN 2008 401k financial data
Transfers to/from the plan	2008-12-31	$0
Total plan liabilities at end of year	2008-12-31	$0
Total plan liabilities at beginning of year	2008-12-31	$0
Total income from all sources	2008-12-31	$-41,278
Expenses. Total of all expenses incurred	2008-12-31	$401,373
Benefits paid (including direct rollovers)	2008-12-31	$401,373
Total plan assets at end of year	2008-12-31	$149,180
Total plan assets at beginning of year	2008-12-31	$591,831
Value of fidelity bond covering the plan	2008-12-31	$80,000
Assets. Value of tangible personal property	2008-12-31	$0
Total contributions received or receivable from participants	2008-12-31	$18,735
Assets. Value of loans (other than to participants)	2008-12-31	$0
Expenses. Other expenses not covered elsewhere	2008-12-31	$0
Contributions received from other sources (not participants or employers)	2008-12-31	$0
Other income received	2008-12-31	$-76,082
Noncash contributions received	2008-12-31	$0
Net income (gross income less expenses)	2008-12-31	$-442,651
Net plan assets at end of year (total assets less liabilities)	2008-12-31	$149,180
Net plan assets at beginning of year (total assets less liabilities)	2008-12-31	$591,831
Assets. Value of participant loans	2008-12-31	$8,241
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	2008-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2008-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2008-12-31	$0
Assets. Value of real-estate (other than employer real property)	2008-12-31	$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	2008-12-31	$0
Assets. Value of employer securities	2008-12-31	$0
Assets. Value of employer real property	2008-12-31	$0
Total contributions received or receivable from employer(s)	2008-12-31	$16,069
Value of certain deemed distributions of participant loans	2008-12-31	$0
Value of corrective distributions	2008-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2008-12-31	$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2008-12-31	0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2008-12-31	$0

Form 5500 Responses for WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN

2010: WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 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
2008: WESTERN CAROLINA UROLOGICAL ASSOCIATES, PA 401(K) PROFIT SHARING PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan funding arrangement – Trust	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-805463

Policy instance

Insurance contract or identification number	GA-805463
Number of Individuals Covered	12
Total amount of commissions paid to insurance broker	USD $627
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?	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
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

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

Policy contract number

GA-805463

Policy instance

Insurance contract or identification number	GA-805463
Number of Individuals Covered	14
Total amount of commissions paid to insurance broker	USD $534
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?	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
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

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

Policy contract number

GA-805463

Policy instance

Insurance contract or identification number	GA-805463
Number of Individuals Covered	14
Total amount of commissions paid to insurance broker	USD $525
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?	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
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:	WESTERN CAROLINA UROLOGICAL
Employer identification number (EIN):	562062493
NAIC Classification:	621399
NAIC Description:	Offices of All Other Miscellaneous Health Practitioners