401k Plan data: GRANT P. SIMMONS PROFIT SHARING PLAN plan

GRANT P. SIMMONS PROFIT SHARING PLAN 401k Plan overview

Plan Name	GRANT P. SIMMONS PROFIT SHARING PLAN
Plan identification number	002

GRANT P. SIMMONS PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Plan covered by PBGC that was terminated and closed out for PBGC purposes - Before the end of the plan year (or a prior plan year), (1) the plan terminated in a standard (or distress) termination and completed the distribution of plan assets in satisfaction of all benefit liabilities (or all ERISA Title IV benefits for distress termination); or (2) a trustee was appointed for a terminated plan pursuant to ERISA section 4042.
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.

401k Sponsoring company profile

NORTHSHORE UROLOGY has sponsored the creation of one or more 401k plans.

Company Name: NORTHSHORE UROLOGY

Employer identification number (EIN): 720770910

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRANT P. SIMMONS PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2012-01-01 GRANT P SIMMONS
002 2011-01-01 GRANT P SIMMONS
002 2010-01-01 GRANT P SIMMONS
002 2009-01-01 GRANT P SIMMONS

Plan id#	Filing Submission Date	Name of Administrator
002	2012-01-01	GRANT P SIMMONS
002	2011-01-01	GRANT P SIMMONS
002	2010-01-01	GRANT P SIMMONS
002	2009-01-01	GRANT P SIMMONS

Plan Statistics for GRANT P. SIMMONS PROFIT SHARING PLAN

401k plan membership statisitcs for GRANT P. SIMMONS PROFIT SHARING PLAN

Measure Date Value
2012: GRANT P. SIMMONS PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 1
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: GRANT P. SIMMONS PROFIT SHARING PLAN 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
Total of all active and inactive participants 2011-01-01 1
Total participants 2011-01-01 1
2010: GRANT P. SIMMONS PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1
Total of all active and inactive participants 2010-01-01 1
Total participants 2010-01-01 1
2009: GRANT P. SIMMONS PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2
Number of retired or separated participants receiving benefits 2009-01-01 4
Total of all active and inactive participants 2009-01-01 6
Total participants 2009-01-01 6

Measure	Date	Value
2012: GRANT P. SIMMONS PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	1
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: GRANT P. SIMMONS PROFIT SHARING PLAN 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
Total of all active and inactive participants	2011-01-01	1
Total participants	2011-01-01	1
2010: GRANT P. SIMMONS PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1
Total of all active and inactive participants	2010-01-01	1
Total participants	2010-01-01	1
2009: GRANT P. SIMMONS PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2
Number of retired or separated participants receiving benefits	2009-01-01	4
Total of all active and inactive participants	2009-01-01	6
Total participants	2009-01-01	6

Financial Data on GRANT P. SIMMONS PROFIT SHARING PLAN

Measure	Date	Value
2012 : GRANT P. SIMMONS PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$-610,969
Total income from all sources	2012-12-31	$61,188
Total plan assets at end of year	2012-12-31	$0
Total plan assets at beginning of year	2012-12-31	$549,781
Other income received	2012-12-31	$61,188
Net income (gross income less expenses)	2012-12-31	$61,188
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$549,781
2011 : GRANT P. SIMMONS PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$13,193
Total plan assets at end of year	2011-12-31	$549,781
Total plan assets at beginning of year	2011-12-31	$536,588
Other income received	2011-12-31	$13,193
Net income (gross income less expenses)	2011-12-31	$13,193
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$549,781
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$536,588
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$169,602
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	$0
2010 : GRANT P. SIMMONS PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$42,281
Expenses. Total of all expenses incurred	2010-12-31	$11,248
Benefits paid (including direct rollovers)	2010-12-31	$11,248
Total plan assets at end of year	2010-12-31	$536,588
Total plan assets at beginning of year	2010-12-31	$505,555
Other income received	2010-12-31	$42,281
Net income (gross income less expenses)	2010-12-31	$31,033
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$536,588
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$505,555
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$182,589

Form 5500 Responses for GRANT P. SIMMONS PROFIT SHARING PLAN

2012: GRANT P. SIMMONS PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	This submission is the final filing	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: GRANT P. SIMMONS PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: GRANT P. SIMMONS PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: GRANT P. SIMMONS PROFIT SHARING PLAN 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

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Company Name:	NORTHSHORE UROLOGY
Employer identification number (EIN):	720770910
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)