401k Plan data: DANIEL J. WADZINSKI DDS PROFIT SHARING PLAN plan

DANIEL J. WADZINSKI DDS PROFIT SHARING PLAN 401k Plan overview

Plan Name	DANIEL J. WADZINSKI DDS PROFIT SHARING PLAN
Plan identification number	002

DANIEL J. WADZINSKI DDS PROFIT SHARING 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.
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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

DANIEL J. WADZINSKI, DDS has sponsored the creation of one or more 401k plans.

Company Name: DANIEL J. WADZINSKI, DDS

Employer identification number (EIN): 391905340

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DANIEL J. WADZINSKI DDS 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 DANIEL WADZINSKI 2013-06-03
002 2011-01-01 DANIEL WADZINSKI
002 2010-01-01 DANIEL J. WADZINSKI, DDS 2011-04-26 DANIEL J. WADZINSKI, DDS 2011-04-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2012-01-01	DANIEL WADZINSKI	2013-06-03
002	2011-01-01	DANIEL WADZINSKI
002	2010-01-01	DANIEL J. WADZINSKI, DDS	2011-04-26	DANIEL J. WADZINSKI, DDS	2011-04-26

Plan Statistics for DANIEL J. WADZINSKI DDS PROFIT SHARING PLAN

401k plan membership statisitcs for DANIEL J. WADZINSKI DDS PROFIT SHARING PLAN

Measure Date Value
2011: DANIEL J. WADZINSKI DDS PROFIT SHARING 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 3
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 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 3
Number of participants with account balances 2011-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2011: DANIEL J. WADZINSKI DDS PROFIT SHARING 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	3
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	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	3
Number of participants with account balances	2011-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on DANIEL J. WADZINSKI DDS PROFIT SHARING PLAN

Measure	Date	Value
2011 : DANIEL J. WADZINSKI DDS PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$60,139
Expenses. Total of all expenses incurred	2011-12-31	$24,146
Benefits paid (including direct rollovers)	2011-12-31	$22,680
Total plan assets at end of year	2011-12-31	$182,602
Total plan assets at beginning of year	2011-12-31	$146,609
Total contributions received or receivable from participants	2011-12-31	$50,441
Other income received	2011-12-31	$2,941
Net income (gross income less expenses)	2011-12-31	$35,993
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$182,602
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$146,609
Total contributions received or receivable from employer(s)	2011-12-31	$6,757
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$1,466
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0

Form 5500 Responses for DANIEL J. WADZINSKI DDS PROFIT SHARING PLAN

2011: DANIEL J. WADZINSKI DDS 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	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 – 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

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

92105

Policy instance

Insurance contract or identification number	92105
Number of Individuals Covered	3
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $708
Total amount of fees paid to insurance company	USD $284
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	DANIEL J. WADZINSKI, DDS
Employer identification number (EIN):	391905340
NAIC Classification:	621210
NAIC Description:	Offices of Dentists