401k Plan data: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN plan

JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 401k Plan overview

Plan Name	JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN
Plan identification number	003

JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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

JOHN A. JANICKE, D.D.S., LTD. has sponsored the creation of one or more 401k plans.

Company Name: JOHN A. JANICKE, D.D.S., LTD.

Employer identification number (EIN): 860332324

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2015-01-01
003 2014-01-01
003 2013-01-01
003 2012-01-01 JOHN A JANICKE, DDS JOHN A JANICKE, DDS 2013-08-29
003 2011-01-01 JOHN A JANICKE, DDS JOHN A JANICKE, DDS 2012-11-14
003 2010-01-01 JOHN A. JANICKE, D.D.S. JOHN A. JANICKE, D.D.S. 2012-11-14
003 2009-01-01 JOHN A. JANICKE, D.D.S.

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
003	2015-01-01
003	2014-01-01
003	2013-01-01
003	2012-01-01	JOHN A JANICKE, DDS	JOHN A JANICKE, DDS	2013-08-29
003	2011-01-01	JOHN A JANICKE, DDS	JOHN A JANICKE, DDS	2012-11-14
003	2010-01-01	JOHN A. JANICKE, D.D.S.	JOHN A. JANICKE, D.D.S.	2012-11-14
003	2009-01-01	JOHN A. JANICKE, D.D.S.

Plan Statistics for JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN

401k plan membership statisitcs for JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN

Measure Date Value
2015: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 2
Number of participants with account balances 2014-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 4
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 4
Number of participants with account balances 2013-01-01 4
2012: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 4
Number of retired or separated participants receiving benefits 2012-01-01 0
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 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 4
Number of participants with account balances 2012-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K 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
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 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
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: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K 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
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 0
Total of all active and inactive participants 2010-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
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: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K 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
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 0
Total of all active and inactive participants 2009-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 4
Number of participants with account balances 2009-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2015: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	2
Number of participants with account balances	2014-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	4
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	4
Number of participants with account balances	2013-01-01	4
2012: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	4
Number of retired or separated participants receiving benefits	2012-01-01	0
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	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	4
Number of participants with account balances	2012-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K 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
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	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
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: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K 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
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	0
Total of all active and inactive participants	2010-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
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: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K 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
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	0
Total of all active and inactive participants	2009-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	4
Number of participants with account balances	2009-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN

Measure	Date	Value
2015 : JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total income from all sources	2015-12-31	$-32,105
Expenses. Total of all expenses incurred	2015-12-31	$173,002
Benefits paid (including direct rollovers)	2015-12-31	$172,932
Total plan assets at end of year	2015-12-31	$0
Total plan assets at beginning of year	2015-12-31	$205,107
Value of fidelity bond covering the plan	2015-12-31	$275,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$70
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-32,105
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-205,107
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$205,107
Total contributions received or receivable from employer(s)	2015-12-31	$0
2014 : JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2014 401k financial data
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$-4,932
Expenses. Total of all expenses incurred	2014-12-31	$19,828
Benefits paid (including direct rollovers)	2014-12-31	$19,828
Total plan assets at end of year	2014-12-31	$205,107
Total plan assets at beginning of year	2014-12-31	$229,867
Value of fidelity bond covering the plan	2014-12-31	$275,000
Other income received	2014-12-31	$-4,932
Net income (gross income less expenses)	2014-12-31	$-24,760
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$205,107
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$229,867
Assets. Value of participant loans	2014-12-31	$8,082
2013 : JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$-178,377
Expenses. Total of all expenses incurred	2013-12-31	$80,743
Benefits paid (including direct rollovers)	2013-12-31	$80,743
Total plan assets at end of year	2013-12-31	$229,867
Total plan assets at beginning of year	2013-12-31	$488,987
Value of fidelity bond covering the plan	2013-12-31	$275,000
Total contributions received or receivable from participants	2013-12-31	$5,183
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$-183,560
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$-259,120
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$229,867
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$488,987
Assets. Value of participant loans	2013-12-31	$9,657
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
2012 : JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$50,125
Expenses. Total of all expenses incurred	2012-12-31	$322,954
Benefits paid (including direct rollovers)	2012-12-31	$321,325
Total plan assets at end of year	2012-12-31	$488,987
Total plan assets at beginning of year	2012-12-31	$761,816
Value of fidelity bond covering the plan	2012-12-31	$275,000
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$1,629
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$50,125
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$-272,829
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$488,987
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$761,816
Assets. Value of participant loans	2012-12-31	$6,417
Total contributions received or receivable from employer(s)	2012-12-31	$0
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
2011 : JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2011 401k financial data
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$-120,332
Expenses. Total of all expenses incurred	2011-12-31	$66,000
Benefits paid (including direct rollovers)	2011-12-31	$66,000
Total plan assets at end of year	2011-12-31	$700,673
Total plan assets at beginning of year	2011-12-31	$887,005
Value of fidelity bond covering the plan	2011-12-31	$275,000
Total contributions received or receivable from participants	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-120,332
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-186,332
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$700,673
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$887,005
Assets. Value of participant loans	2011-12-31	$13,724
Assets. Value of real-estate (other than employer real property)	2011-12-31	$226,000
Total contributions received or receivable from employer(s)	2011-12-31	$0
2010 : JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K 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	$213,124
Expenses. Total of all expenses incurred	2010-12-31	$116,586
Benefits paid (including direct rollovers)	2010-12-31	$113,500
Total plan assets at end of year	2010-12-31	$887,005
Total plan assets at beginning of year	2010-12-31	$790,467
Value of fidelity bond covering the plan	2010-12-31	$275,000
Total contributions received or receivable from participants	2010-12-31	$123
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$213,001
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$96,538
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$887,005
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$790,467
Assets. Value of participant loans	2010-12-31	$15,900
Total contributions received or receivable from employer(s)	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$3,086
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN

2015: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	Yes
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K 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	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: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
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
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: JOHN A. JANICKE, D.D.S., LTD. EMPLOYEES 401K 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 – 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

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-54-T427

Policy instance

Insurance contract or identification number	GAP-54-T427
Number of Individuals Covered	0
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $392
Total amount of fees paid to insurance company	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:	JOHN A. JANICKE, D.D.S., LTD.
Employer identification number (EIN):	860332324
NAIC Classification:	621210
NAIC Description:	Offices of Dentists