401k Plan data: RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING plan

RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING 401k Plan overview

Plan Name	RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING
Plan identification number	002

RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Profit-sharing

401k Sponsoring company profile

RICARDO E JIMENEZ has sponsored the creation of one or more 401k plans.

Company Name: RICARDO E JIMENEZ

Employer identification number (EIN): 660500997

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2011-01-01 RICARDO E. JIMENEZ RICARDO E. JIMENEZ 2012-10-05
002 2009-01-01 RICARDO E. JIMENEZ RICARDO E. JIMENEZ 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2011-01-01	RICARDO E. JIMENEZ		RICARDO E. JIMENEZ	2012-10-05
002	2009-01-01	RICARDO E. JIMENEZ		RICARDO E. JIMENEZ	2010-10-14

Plan Statistics for RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING

401k plan membership statisitcs for RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING

Measure Date Value
2011: RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1
Number of participants with account balances 2011-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1
Total of all active and inactive participants 2009-01-01 1
Total participants 2009-01-01 1
Number of participants with account balances 2009-01-01 1

Measure	Date	Value
2011: RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1
Number of participants with account balances	2011-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1
Total of all active and inactive participants	2009-01-01	1
Total participants	2009-01-01	1
Number of participants with account balances	2009-01-01	1

Financial Data on RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING

Measure	Date	Value
2011 : RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING 2011 401k financial data
Total income from all sources	2011-12-31	$49,664
Total plan assets at end of year	2011-12-31	$601,269
Total plan assets at beginning of year	2011-12-31	$551,605
Other income received	2011-12-31	$-3,465
Net income (gross income less expenses)	2011-12-31	$49,664
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$601,269
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$551,605
Total contributions received or receivable from employer(s)	2011-12-31	$53,129
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$53,129
Amount contributed by the employer to the plan for this plan year	2011-12-31	$53,129
2010 : RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING 2010 401k financial data
Total income from all sources	2010-12-31	$112,424
Expenses. Total of all expenses incurred	2010-12-31	$5,240
Total plan assets at end of year	2010-12-31	$551,605
Total plan assets at beginning of year	2010-12-31	$444,421
Expenses. Other expenses not covered elsewhere	2010-12-31	$5,240
Other income received	2010-12-31	$43,346
Net income (gross income less expenses)	2010-12-31	$107,184
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$551,605
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$444,421
Total contributions received or receivable from employer(s)	2010-12-31	$69,078
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$69,078
Amount contributed by the employer to the plan for this plan year	2010-12-31	$69,078
2009 : RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING 2009 401k financial data
Minimum employer required contribution for this plan year	2009-12-31	$54,566
Amount contributed by the employer to the plan for this plan year	2009-12-31	$54,566

Form 5500 Responses for RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING

2011: RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: RICARDO E. JIMENEZ PENSION PLAN PROFIT SHARING 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

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Company Name:	RICARDO E JIMENEZ
Employer identification number (EIN):	660500997
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)