MICHAEL E. JACOBS PROFIT SHARING RETIREMENT PLAN 611A STATE ROAD VINEYARD HAVEN, MA 02568 401k Plan overview

MICHAEL E. JACOBS PROFIT SHARING RETIREMENT PLAN 611A STATE ROAD VINEYARD HAVEN, MA 02568 Benefits

401k Sponsoring company profile

Company Name:	MICHAEL E. JACOBS
Employer identification number (EIN):	042848079
NAIC Classification:	621112
NAIC Description:	Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2009-01-01	MICHAEL JACOBS		MICHAEL E JACOBS	2010-07-15
001	2009-01-01	MICHAEL JACOBS

Plan Statistics for MICHAEL E. JACOBS PROFIT SHARING RETIREMENT PLAN 611A STATE ROAD VINEYARD HAVEN, MA 02568

Measure	Date	Value
2009: MICHAEL E. JACOBS PROFIT SHARING RETIREMENT PLAN 611A STATE ROAD VINEYARD HAVEN, MA 02568 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

Form 5500 Responses for MICHAEL E. JACOBS PROFIT SHARING RETIREMENT PLAN 611A STATE ROAD VINEYARD HAVEN, MA 02568

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