401k Plan data: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN plan

AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN
Plan identification number	001

AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Profit-sharing 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

AMERICAN DENTAL ACCESSORIES, INC. has sponsored the creation of one or more 401k plans.

Company Name: AMERICAN DENTAL ACCESSORIES, INC.

Employer identification number (EIN): 411608330

NAIC Classification: 446190

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 JAMES O. HAGEN
001 2012-01-01 JAMES O. HAGEN
001 2011-01-01 JAMES O. HAGEN
001 2009-01-01 JAMES O. HAGEN

Plan id#	Filing Submission Date	Name of Administrator
001	2013-01-01	JAMES O. HAGEN
001	2012-01-01	JAMES O. HAGEN
001	2011-01-01	JAMES O. HAGEN
001	2009-01-01	JAMES O. HAGEN

Plan Statistics for AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN

Measure Date Value
2013: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 19
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 0
Number of participants with account balances 2013-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 19
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 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 19
Number of participants with account balances 2012-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 21
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 21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 21
Number of participants with account balances 2011-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 19
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 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 19
Number of participants with account balances 2009-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 3

Measure	Date	Value
2013: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	19
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	0
Number of participants with account balances	2013-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	19
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	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	19
Number of participants with account balances	2012-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	21
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	21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	21
Number of participants with account balances	2011-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	19
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	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	19
Number of participants with account balances	2009-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	3

Financial Data on AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN

Measure	Date	Value
2013 : AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$222,250
Expenses. Total of all expenses incurred	2013-12-31	$2,360,928
Benefits paid (including direct rollovers)	2013-12-31	$2,360,928
Total plan assets at end of year	2013-12-31	$0
Total plan assets at beginning of year	2013-12-31	$2,138,678
Other income received	2013-12-31	$222,250
Net income (gross income less expenses)	2013-12-31	$-2,138,678
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,138,678
2012 : AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$224,768
Expenses. Total of all expenses incurred	2012-12-31	$40,798
Benefits paid (including direct rollovers)	2012-12-31	$40,798
Total plan assets at end of year	2012-12-31	$2,138,678
Total plan assets at beginning of year	2012-12-31	$1,954,708
Other income received	2012-12-31	$196,444
Net income (gross income less expenses)	2012-12-31	$183,970
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,138,678
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,954,708
Total contributions received or receivable from employer(s)	2012-12-31	$28,324
2011 : AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$76,269
Total plan assets at end of year	2011-12-31	$1,954,708
Total plan assets at beginning of year	2011-12-31	$1,878,439
Other income received	2011-12-31	$48,485
Net income (gross income less expenses)	2011-12-31	$76,269
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,954,708
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,878,439
Total contributions received or receivable from employer(s)	2011-12-31	$27,784
2010 : AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$122,925
Expenses. Total of all expenses incurred	2010-12-31	$12,217
Benefits paid (including direct rollovers)	2010-12-31	$12,217
Total plan assets at end of year	2010-12-31	$1,878,439
Total plan assets at beginning of year	2010-12-31	$1,767,731
Other income received	2010-12-31	$105,791
Net income (gross income less expenses)	2010-12-31	$110,708
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,878,439
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,767,731
Total contributions received or receivable from employer(s)	2010-12-31	$17,134

Form 5500 Responses for AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN

2013: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	This submission is the final filing	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: AMERICAN DENTAL ACCESSORIES, INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	AMERICAN DENTAL ACCESSORIES, INC.
Employer identification number (EIN):	411608330
NAIC Classification:	446190