401k Plan data: G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN plan

G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 401k Plan overview

Plan Name	G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN
Plan identification number	001

G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
Plan covering Self-Employed individuals.
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

G. MICHAEL DAVIS, D.D.S. has sponsored the creation of one or more 401k plans.

Company Name: G. MICHAEL DAVIS, D.D.S.

Employer identification number (EIN): 720894569

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan G. MICHAEL DAVIS, D.D.S. 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 GEORGE M. DAVIS 2013-08-26
001 2011-01-01 GEORGE M. DAVIS
001 2010-01-01 GEORGE M. DAVIS
001 2009-01-01 GEORGE M. DAVIS
001 2009-01-01 GEORGE M. DAVIS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2012-01-01	GEORGE M. DAVIS	2013-08-26
001	2011-01-01	GEORGE M. DAVIS
001	2010-01-01	GEORGE M. DAVIS
001	2009-01-01	GEORGE M. DAVIS
001	2009-01-01	GEORGE M. DAVIS

Plan Statistics for G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN

401k plan membership statisitcs for G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN

Measure Date Value
2011: G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
Number of other retired or separated participants entitled to future benefits 2011-01-01 4
Total of all active and inactive participants 2011-01-01 8
Total participants 2011-01-01 8
Number of participants with account balances 2011-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 2
2010: G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 6
Number of other retired or separated participants entitled to future benefits 2010-01-01 2
Total of all active and inactive participants 2010-01-01 8
Total participants 2010-01-01 8
Number of participants with account balances 2010-01-01 8
2009: G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 4
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 3
Total of all active and inactive participants 2009-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 7
Number of participants with account balances 2009-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
Number of other retired or separated participants entitled to future benefits	2011-01-01	4
Total of all active and inactive participants	2011-01-01	8
Total participants	2011-01-01	8
Number of participants with account balances	2011-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	2
2010: G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	6
Number of other retired or separated participants entitled to future benefits	2010-01-01	2
Total of all active and inactive participants	2010-01-01	8
Total participants	2010-01-01	8
Number of participants with account balances	2010-01-01	8
2009: G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	4
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	7
Number of participants with account balances	2009-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN

Measure	Date	Value
2011 : G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$10,714
Expenses. Total of all expenses incurred	2011-12-31	$9,178
Total plan assets at end of year	2011-12-31	$645,219
Total plan assets at beginning of year	2011-12-31	$643,683
Value of fidelity bond covering the plan	2011-12-31	$70,000
Other income received	2011-12-31	$-13,737
Net income (gross income less expenses)	2011-12-31	$1,536
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$645,219
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$643,683
Total contributions received or receivable from employer(s)	2011-12-31	$24,451
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$9,178
2010 : G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 2010 401k financial data
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	$79,485
Expenses. Total of all expenses incurred	2010-12-31	$8,370
Total plan assets at end of year	2010-12-31	$643,683
Total plan assets at beginning of year	2010-12-31	$572,568
Value of fidelity bond covering the plan	2010-12-31	$70,000
Other income received	2010-12-31	$53,700
Net income (gross income less expenses)	2010-12-31	$71,115
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$643,683
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$572,568
Total contributions received or receivable from employer(s)	2010-12-31	$25,785
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$8,370

Form 5500 Responses for G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN

2011: G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: G. MICHAEL DAVIS, D.D.S. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

5092787

Policy instance

Insurance contract or identification number	5092787
Number of Individuals Covered	8
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

5092787

Policy instance

Insurance contract or identification number	5092787
Number of Individuals Covered	8
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	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:	G. MICHAEL DAVIS, D.D.S.
Employer identification number (EIN):	720894569
NAIC Classification:	621210
NAIC Description:	Offices of Dentists