401k Plan data: ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN plan

ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN 401k Plan overview

Plan Name	ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN
Plan identification number	001

ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Profit-sharing Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

ORTHODONTICS EAST, P.A. has sponsored the creation of one or more 401k plans.

Company Name: ORTHODONTICS EAST, P.A.

Employer identification number (EIN): 630759179

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 GEORGE A. NELSON III 2014-06-12 GEORGE A. NELSON III 2014-06-12
001 2012-01-01 GEORGE A. NELSON III 2013-07-27 GEORGE A. NELSON III 2013-07-27
001 2011-01-01 GEORGE A. NELSON III GEORGE A. NELSON III 2013-08-01
001 2010-01-01 GEORGE A. NELSON III
001 2009-01-01 GEORGE A. NELSON III

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2013-01-01	GEORGE A. NELSON III	2014-06-12	GEORGE A. NELSON III	2014-06-12
001	2012-01-01	GEORGE A. NELSON III	2013-07-27	GEORGE A. NELSON III	2013-07-27
001	2011-01-01	GEORGE A. NELSON III		GEORGE A. NELSON III	2013-08-01
001	2010-01-01	GEORGE A. NELSON III
001	2009-01-01	GEORGE A. NELSON III

Plan Statistics for ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN

401k plan membership statisitcs for ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN

Measure Date Value
2011: ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
Total of all active and inactive participants 2011-01-01 4
Total participants 2011-01-01 4
Number of participants with account balances 2011-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 4
Total of all active and inactive participants 2010-01-01 4
Total participants 2010-01-01 4
Number of participants with account balances 2010-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 4
Total of all active and inactive participants 2009-01-01 4
Total participants 2009-01-01 4
Number of participants with account balances 2009-01-01 4

Measure	Date	Value
2011: ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
Total of all active and inactive participants	2011-01-01	4
Total participants	2011-01-01	4
Number of participants with account balances	2011-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	4
Total of all active and inactive participants	2010-01-01	4
Total participants	2010-01-01	4
Number of participants with account balances	2010-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	4
Total of all active and inactive participants	2009-01-01	4
Total participants	2009-01-01	4
Number of participants with account balances	2009-01-01	4

Financial Data on ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN

Measure	Date	Value
2011 : ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$965
Total plan assets at end of year	2011-12-31	$2,119,032
Total plan assets at beginning of year	2011-12-31	$2,118,067
Value of fidelity bond covering the plan	2011-12-31	$250,000
Other income received	2011-12-31	$965
Net income (gross income less expenses)	2011-12-31	$965
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,119,032
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,118,067
2010 : ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$165,501
Total plan assets at end of year	2010-12-31	$2,118,067
Total plan assets at beginning of year	2010-12-31	$1,952,566
Value of fidelity bond covering the plan	2010-12-31	$250,000
Other income received	2010-12-31	$165,501
Net income (gross income less expenses)	2010-12-31	$165,501
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,118,067
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,952,566
Assets. Value of participant loans	2010-12-31	$6,038

Form 5500 Responses for ORTHODONTICS EAST, P.A. PROFIT SHARING PLAN

2011: ORTHODONTICS EAST, P.A. 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: ORTHODONTICS EAST, P.A. 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 – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: ORTHODONTICS EAST, P.A. 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 – Trust	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

14381

Policy instance

Insurance contract or identification number	14381
Number of Individuals Covered	1
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
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
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

14381

Policy instance

Insurance contract or identification number	14381
Number of Individuals Covered	1
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ORTHODONTICS EAST, P.A.
Employer identification number (EIN):	630759179
NAIC Classification:	621210
NAIC Description:	Offices of Dentists