401k Plan data: THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN plan

THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN 401k Plan overview

Plan Name	THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN
Plan identification number	002

THOMAS D. WAIS, D.D.S., P.C. 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
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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

THOMAS D. WAIS, D.D.S., P.C. has sponsored the creation of one or more 401k plans.

Company Name: THOMAS D. WAIS, D.D.S., P.C.

Employer identification number (EIN): 426219355

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01 THOMAS D. WAIS, DDS 2016-12-13
002 2015-01-01 THOMAS D. WAIS, DDS 2016-08-03
002 2014-01-01 THOMAS D. WAIS, DDS 2015-10-12
002 2013-01-01 THOMAS D. WAIS, DDS 2014-10-13
002 2012-01-01 THOMAS D. WAIS, DDS 2013-09-23
002 2011-01-01 THOMAS D. WAIS, DDS 2012-10-10
002 2009-01-01 THOMAS D. WAIS, DDS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2016-01-01	THOMAS D. WAIS, DDS	2016-12-13
002	2015-01-01	THOMAS D. WAIS, DDS	2016-08-03
002	2014-01-01	THOMAS D. WAIS, DDS	2015-10-12
002	2013-01-01	THOMAS D. WAIS, DDS	2014-10-13
002	2012-01-01	THOMAS D. WAIS, DDS	2013-09-23
002	2011-01-01	THOMAS D. WAIS, DDS	2012-10-10
002	2009-01-01	THOMAS D. WAIS, DDS

Plan Statistics for THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN

401k plan membership statisitcs for THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN

Measure Date Value
2009: THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 3
Number of other retired or separated participants entitled to future benefits 2009-01-01 3
Total of all active and inactive participants 2009-01-01 6
Total participants 2009-01-01 6
Number of participants with account balances 2009-01-01 5

Measure	Date	Value
2009: THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	3
Number of other retired or separated participants entitled to future benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	6
Total participants	2009-01-01	6
Number of participants with account balances	2009-01-01	5

Financial Data on THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN

Measure	Date	Value
2010 : THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$15,919
Expenses. Total of all expenses incurred	2010-12-31	$17,702
Benefits paid (including direct rollovers)	2010-12-31	$14,957
Total plan assets at end of year	2010-12-31	$264,331
Total plan assets at beginning of year	2010-12-31	$266,114
Value of fidelity bond covering the plan	2010-12-31	$30,000
Other income received	2010-12-31	$15,919
Net income (gross income less expenses)	2010-12-31	$-1,783
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$264,331
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$266,114
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$2,745

Form 5500 Responses for THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN

2009: THOMAS D. WAIS, D.D.S., P.C. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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

AVIVA LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 60631 )

Policy contract number

575913

Policy instance

Insurance contract or identification number	575913
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71153 )

Policy contract number

Policy instance

Insurance contract or identification number	3
Number of Individuals Covered	3
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

Policy instance

Insurance contract or identification number	3
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Are there contracts with allocated funds for individual policies?	Yes
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:	THOMAS D. WAIS, D.D.S., P.C.
Employer identification number (EIN):	426219355
NAIC Classification:	621210
NAIC Description:	Offices of Dentists