401k Plan data: PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN plan

PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN
Plan identification number	002

PAUL LARSON OB-GYN CLINIC, P.A. 401(K) 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
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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

PAUL LARSON OB-GYN CLINIC, P.A. has sponsored the creation of one or more 401k plans.

Company Name: PAUL LARSON OB-GYN CLINIC, P.A.

Employer identification number (EIN): 410853872

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2015-10-01 DARVIA K. HEROLD 2016-04-29 DARVIA K. HEROLD 2016-04-29
002 2014-10-01 DARVIA K. HEROLD 2016-04-19 DARVIA K. HEROLD 2016-04-19
002 2013-10-01 DARVIA K. HEROLD 2014-12-29 DARVIA K. HEROLD 2014-12-29
002 2012-10-01 DARVIA K HEROLD 2014-02-10
002 2011-10-01 DARVIA HEROLD 2013-04-18 DARVIA HEROLD 2013-04-18
002 2010-10-01 DARVIA HEROLD
002 2009-10-01 DARVIA HEROLD
002 2008-10-01
002 2007-10-01 DARVIA HEROLD

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2015-10-01	DARVIA K. HEROLD	2016-04-29	DARVIA K. HEROLD	2016-04-29
002	2014-10-01	DARVIA K. HEROLD	2016-04-19	DARVIA K. HEROLD	2016-04-19
002	2013-10-01	DARVIA K. HEROLD	2014-12-29	DARVIA K. HEROLD	2014-12-29
002	2012-10-01	DARVIA K HEROLD	2014-02-10
002	2011-10-01	DARVIA HEROLD	2013-04-18	DARVIA HEROLD	2013-04-18
002	2010-10-01	DARVIA HEROLD
002	2009-10-01	DARVIA HEROLD
002	2008-10-01
002	2007-10-01	DARVIA HEROLD

Plan Statistics for PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN

Measure Date Value
2010: PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-10-01 46
Total number of active participants reported on line 7a of the Form 5500 2010-10-01 29
Number of retired or separated participants receiving benefits 2010-10-01 0
Number of other retired or separated participants entitled to future benefits 2010-10-01 14
Total of all active and inactive participants 2010-10-01 43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-10-01 0
Total participants 2010-10-01 43
Number of participants with account balances 2010-10-01 43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-10-01 0
2009: PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 49
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 31
Number of retired or separated participants receiving benefits 2009-10-01 0
Number of other retired or separated participants entitled to future benefits 2009-10-01 15
Total of all active and inactive participants 2009-10-01 46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-10-01 0
Total participants 2009-10-01 46
Number of participants with account balances 2009-10-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-10-01 2
2007: PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2007 401k membership
Total participants, beginning-of-year 2007-10-01 41
Total number of active participants reported on line 7a of the Form 5500 2007-10-01 39
Number of retired or separated participants receiving benefits 2007-10-01 1
Number of other retired or separated participants entitled to future benefits 2007-10-01 9
Total of all active and inactive participants 2007-10-01 49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2007-10-01 0
Total participants 2007-10-01 49
Number of participants with account balances 2007-10-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2007-10-01 3

Measure	Date	Value
2010: PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-10-01	46
Total number of active participants reported on line 7a of the Form 5500	2010-10-01	29
Number of retired or separated participants receiving benefits	2010-10-01	0
Number of other retired or separated participants entitled to future benefits	2010-10-01	14
Total of all active and inactive participants	2010-10-01	43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-10-01	0
Total participants	2010-10-01	43
Number of participants with account balances	2010-10-01	43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-10-01	0
2009: PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	49
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	31
Number of retired or separated participants receiving benefits	2009-10-01	0
Number of other retired or separated participants entitled to future benefits	2009-10-01	15
Total of all active and inactive participants	2009-10-01	46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-10-01	0
Total participants	2009-10-01	46
Number of participants with account balances	2009-10-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-10-01	2
2007: PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2007 401k membership
Total participants, beginning-of-year	2007-10-01	41
Total number of active participants reported on line 7a of the Form 5500	2007-10-01	39
Number of retired or separated participants receiving benefits	2007-10-01	1
Number of other retired or separated participants entitled to future benefits	2007-10-01	9
Total of all active and inactive participants	2007-10-01	49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2007-10-01	0
Total participants	2007-10-01	49
Number of participants with account balances	2007-10-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2007-10-01	3

Financial Data on PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2011 : PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-09-30	$285,721
Expenses. Total of all expenses incurred	2011-09-30	$178,815
Benefits paid (including direct rollovers)	2011-09-30	$160,930
Total plan assets at end of year	2011-09-30	$4,860,211
Total plan assets at beginning of year	2011-09-30	$4,753,305
Value of fidelity bond covering the plan	2011-09-30	$500,000
Total contributions received or receivable from participants	2011-09-30	$151,523
Expenses. Other expenses not covered elsewhere	2011-09-30	$17,885
Other income received	2011-09-30	$60,897
Net income (gross income less expenses)	2011-09-30	$106,906
Net plan assets at end of year (total assets less liabilities)	2011-09-30	$4,860,211
Net plan assets at beginning of year (total assets less liabilities)	2011-09-30	$4,753,305
Assets. Value of participant loans	2011-09-30	$39,824
Total contributions received or receivable from employer(s)	2011-09-30	$73,301
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-09-30	$0
2010 : PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-09-30	$0

Form 5500 Responses for PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN

2010: PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	Submission has been amended	No
2010-10-01	This submission is the final filing	No
2010-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-10-01	Plan is a collectively bargained plan	No
2010-10-01	Plan funding arrangement – Trust	Yes
2010-10-01	Plan benefit arrangement - Trust	Yes
2009: PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan funding arrangement – Trust	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement - Trust	Yes
2008: PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2008 form 5500 responses
2008-10-01	Type of plan entity	Single employer plan
2008-10-01	Submission has been amended	No
2008-10-01	This submission is the final filing	No
2008-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-10-01	Plan is a collectively bargained plan	No
2007: PAUL LARSON OB-GYN CLINIC, P.A. 401(K) PROFIT SHARING PLAN 2007 form 5500 responses
2007-10-01	Type of plan entity	Single employer plan
2007-10-01	Submission has been amended	Yes
2007-10-01	This submission is the final filing	No
2007-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-10-01	Plan is a collectively bargained plan	No
2007-10-01	Plan funding arrangement – Insurance	Yes
2007-10-01	Plan funding arrangement – Trust	Yes
2007-10-01	Plan benefit arrangement – Insurance	Yes
2007-10-01	Plan benefit arrangement - Trust	Yes

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Company Name:	PAUL LARSON OB-GYN CLINIC, P.A.
Employer identification number (EIN):	410853872
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)