401k Plan data: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN plan

JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 401k Plan overview

Plan Name	JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN
Plan identification number	001

JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Profit-sharing Plan covering Self-Employed individuals. 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

JOHN F. BEMBRY, D.D.S. has sponsored the creation of one or more 401k plans.

Company Name: JOHN F. BEMBRY, D.D.S.

Employer identification number (EIN): 591310611

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 CANITA GUNTER PETERSON
001 2011-01-01 CANITA GUNTER PETERSON
001 2010-01-01 CANITA GUNTER PETERSON
001 2009-01-01 CANITA GUNTER PETERSON

Plan id#	Filing Submission Date	Name of Administrator
001	2012-01-01	CANITA GUNTER PETERSON
001	2011-01-01	CANITA GUNTER PETERSON
001	2010-01-01	CANITA GUNTER PETERSON
001	2009-01-01	CANITA GUNTER PETERSON

Plan Statistics for JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN

401k plan membership statisitcs for JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN

Measure Date Value
2012: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 0
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1
Number of other retired or separated participants entitled to future benefits 2011-01-01 1
Total of all active and inactive participants 2011-01-01 1
Total participants 2011-01-01 1
Number of participants with account balances 2011-01-01 1
2010: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1
Number of other retired or separated participants entitled to future benefits 2010-01-01 1
Total of all active and inactive participants 2010-01-01 1
Total participants 2010-01-01 1
Number of participants with account balances 2010-01-01 1
2009: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 2
Number of other retired or separated participants entitled to future benefits 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

Measure	Date	Value
2012: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	0
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1
Number of other retired or separated participants entitled to future benefits	2011-01-01	1
Total of all active and inactive participants	2011-01-01	1
Total participants	2011-01-01	1
Number of participants with account balances	2011-01-01	1
2010: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1
Number of other retired or separated participants entitled to future benefits	2010-01-01	1
Total of all active and inactive participants	2010-01-01	1
Total participants	2010-01-01	1
Number of participants with account balances	2010-01-01	1
2009: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	2
Number of other retired or separated participants entitled to future benefits	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

Financial Data on JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN

Measure	Date	Value
2012 : JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-04-11	$110
Expenses. Total of all expenses incurred	2012-04-11	$30,058
Benefits paid (including direct rollovers)	2012-04-11	$30,058
Total plan assets at end of year	2012-04-11	$0
Total plan assets at beginning of year	2012-04-11	$29,948
Other income received	2012-04-11	$110
Net income (gross income less expenses)	2012-04-11	$-29,948
Net plan assets at end of year (total assets less liabilities)	2012-04-11	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-04-11	$29,948
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-04-11	$0
Minimum employer required contribution for this plan year	2012-04-11	$0
Amount contributed by the employer to the plan for this plan year	2012-04-11	$0
2011 : JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$1,493
Total plan assets at end of year	2011-12-31	$29,948
Total plan assets at beginning of year	2011-12-31	$28,455
Other income received	2011-12-31	$1,493
Net income (gross income less expenses)	2011-12-31	$1,493
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$29,948
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$28,455
2010 : JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$1,440
Total plan assets at end of year	2010-12-31	$28,455
Total plan assets at beginning of year	2010-12-31	$27,015
Other income received	2010-12-31	$1,440
Net income (gross income less expenses)	2010-12-31	$1,440
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$28,455
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$27,015

Form 5500 Responses for JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN

2012: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	This submission is the final filing	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: JOHN F. BEMBRY, D.D.S., P.A. PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: JOHN F. BEMBRY, D.D.S., P.A. 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

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Company Name:	JOHN F. BEMBRY, D.D.S.
Employer identification number (EIN):	591310611
NAIC Classification:	621210
NAIC Description:	Offices of Dentists