401k Plan data: KIRAN R. MODI, MD, PA 401(K) PLAN plan

KIRAN R. MODI, MD, PA 401(K) PLAN 401k Plan overview

Plan Name	KIRAN R. MODI, MD, PA 401(K) PLAN
Plan identification number	002

KIRAN R. MODI, MD, PA 401(K) PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	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.

401k Sponsoring company profile

KIRAN R. MODI MD PA has sponsored the creation of one or more 401k plans.

Company Name: KIRAN R. MODI MD PA

Employer identification number (EIN): 593339594

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KIRAN R. MODI, MD, PA 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2012-01-01 KIRAN R MODI MD
002 2011-01-01 KIRAN R MODI MD
002 2010-01-01 KIRAN R MODI MD

Plan id#	Filing Submission Date	Name of Administrator
002	2012-01-01	KIRAN R MODI MD
002	2011-01-01	KIRAN R MODI MD
002	2010-01-01	KIRAN R MODI MD

Plan Statistics for KIRAN R. MODI, MD, PA 401(K) PLAN

401k plan membership statisitcs for KIRAN R. MODI, MD, PA 401(K) PLAN

Measure Date Value
2012: KIRAN R. MODI, MD, PA 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 4
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: KIRAN R. MODI, MD, PA 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
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 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 4
Number of participants with account balances 2011-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 3
2010: KIRAN R. MODI, MD, PA 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 7
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 7
Number of participants with account balances 2010-01-01 7

Measure	Date	Value
2012: KIRAN R. MODI, MD, PA 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	4
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: KIRAN R. MODI, MD, PA 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
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	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	4
Number of participants with account balances	2011-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	3
2010: KIRAN R. MODI, MD, PA 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	7
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	7
Number of participants with account balances	2010-01-01	7

Financial Data on KIRAN R. MODI, MD, PA 401(K) PLAN

Measure	Date	Value
2012 : KIRAN R. MODI, MD, PA 401(K) PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$11,586
Expenses. Total of all expenses incurred	2012-12-31	$187,512
Benefits paid (including direct rollovers)	2012-12-31	$187,512
Total plan assets at end of year	2012-12-31	$0
Total plan assets at beginning of year	2012-12-31	$175,926
Value of fidelity bond covering the plan	2012-12-31	$10,000
Other income received	2012-12-31	$11,586
Net income (gross income less expenses)	2012-12-31	$-175,926
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$175,926
2011 : KIRAN R. MODI, MD, PA 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$85,540
Total plan assets at end of year	2011-12-31	$175,926
Total plan assets at beginning of year	2011-12-31	$90,386
Value of fidelity bond covering the plan	2011-12-31	$10,000
Total contributions received or receivable from participants	2011-12-31	$44,000
Other income received	2011-12-31	$-8,895
Net income (gross income less expenses)	2011-12-31	$85,540
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$175,926
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$90,386
Total contributions received or receivable from employer(s)	2011-12-31	$50,435
2010 : KIRAN R. MODI, MD, PA 401(K) PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$90,386
Total plan assets at end of year	2010-12-31	$90,386
Value of fidelity bond covering the plan	2010-12-31	$10,000
Total contributions received or receivable from participants	2010-12-31	$39,000
Net income (gross income less expenses)	2010-12-31	$90,386
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$90,386
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$0
Total contributions received or receivable from employer(s)	2010-12-31	$51,386

Form 5500 Responses for KIRAN R. MODI, MD, PA 401(K) PLAN

2012: KIRAN R. MODI, MD, PA 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	This submission is the final filing	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: KIRAN R. MODI, MD, PA 401(K) 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
2010: KIRAN R. MODI, MD, PA 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	First time form 5500 has been submitted	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	KIRAN R. MODI MD PA
Employer identification number (EIN):	593339594
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)