401k Plan data: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN plan

RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 401k Plan overview

Plan Name	RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN
Plan identification number	002

RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED 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.
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

RICHARD D. FEWELL DDS, MS AND CHRISTOPHER P. FOGARTY DMD, MS, PC has sponsored the creation of one or more 401k plans.

Company Name: RICHARD D. FEWELL DDS, MS AND CHRISTOPHER P. FOGARTY DMD, MS, PC

Employer identification number (EIN): 621033680

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2020-01-01
002 2019-01-01
002 2018-01-01 RICHARD D FEWELL RICHARD D FEWELL 2019-06-07
002 2017-01-01 RICHARD D FEWELL RICHARD D FEWELL 2018-06-22
002 2016-01-01 RICHARD D FEWELL RICHARD D FEWELL 2017-05-02
002 2015-01-01 RICHARD D FEWELL RICHARD D FEWELL 2016-06-15
002 2014-01-01 RICHARD D FEWELL RICHARD D FEWELL 2015-03-30
002 2013-01-01 RICHARD D FEWELL RICHARD D FEWELL 2014-04-30
002 2012-01-01 RICHARD D FEWELL RICHARD D FEWELL 2013-05-31
002 2011-01-01 RICHARD D FEWELL RICHARD D FEWELL 2012-10-12
002 2009-01-01 RICHARD FEWELL RICHARD FEWELL 2010-09-07

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2020-01-01
002	2019-01-01
002	2018-01-01	RICHARD D FEWELL	RICHARD D FEWELL	2019-06-07
002	2017-01-01	RICHARD D FEWELL	RICHARD D FEWELL	2018-06-22
002	2016-01-01	RICHARD D FEWELL	RICHARD D FEWELL	2017-05-02
002	2015-01-01	RICHARD D FEWELL	RICHARD D FEWELL	2016-06-15
002	2014-01-01	RICHARD D FEWELL	RICHARD D FEWELL	2015-03-30
002	2013-01-01	RICHARD D FEWELL	RICHARD D FEWELL	2014-04-30
002	2012-01-01	RICHARD D FEWELL	RICHARD D FEWELL	2013-05-31
002	2011-01-01	RICHARD D FEWELL	RICHARD D FEWELL	2012-10-12
002	2009-01-01	RICHARD FEWELL	RICHARD FEWELL	2010-09-07

Plan Statistics for RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN

401k plan membership statisitcs for RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN

Measure Date Value
2020: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 19
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 13
Total of all active and inactive participants 2020-01-01 32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 32
Number of participants with account balances 2020-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 18
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 12
Total of all active and inactive participants 2019-01-01 30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 30
Number of participants with account balances 2019-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 17
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 11
Total of all active and inactive participants 2018-01-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 28
Number of participants with account balances 2018-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 20
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 8
Total of all active and inactive participants 2017-01-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 28
Number of participants with account balances 2017-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 20
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 11
Total of all active and inactive participants 2016-01-01 31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 31
Number of participants with account balances 2016-01-01 31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 18
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 11
Total of all active and inactive participants 2015-01-01 29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 29
Number of participants with account balances 2015-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 30
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 18
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 11
Total of all active and inactive participants 2014-01-01 29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 29
Number of participants with account balances 2014-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 31
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 19
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 11
Total of all active and inactive participants 2013-01-01 30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 30
Number of participants with account balances 2013-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 18
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 9
Total of all active and inactive participants 2012-01-01 27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 27
Number of participants with account balances 2012-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 17
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 11
Total of all active and inactive participants 2011-01-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 28
Number of participants with account balances 2011-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 27
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 8
Total of all active and inactive participants 2009-01-01 27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 27
Number of participants with account balances 2009-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2020: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	19
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	13
Total of all active and inactive participants	2020-01-01	32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	32
Number of participants with account balances	2020-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	18
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	12
Total of all active and inactive participants	2019-01-01	30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	30
Number of participants with account balances	2019-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	17
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	11
Total of all active and inactive participants	2018-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	28
Number of participants with account balances	2018-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	20
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	8
Total of all active and inactive participants	2017-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	28
Number of participants with account balances	2017-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	20
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	11
Total of all active and inactive participants	2016-01-01	31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	31
Number of participants with account balances	2016-01-01	31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	18
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	11
Total of all active and inactive participants	2015-01-01	29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	29
Number of participants with account balances	2015-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	30
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	18
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	11
Total of all active and inactive participants	2014-01-01	29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	29
Number of participants with account balances	2014-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	19
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	11
Total of all active and inactive participants	2013-01-01	30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	30
Number of participants with account balances	2013-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	18
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	9
Total of all active and inactive participants	2012-01-01	27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	27
Number of participants with account balances	2012-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	17
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	11
Total of all active and inactive participants	2011-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	28
Number of participants with account balances	2011-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	27
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	8
Total of all active and inactive participants	2009-01-01	27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	27
Number of participants with account balances	2009-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN

Measure	Date	Value
2020 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2020 401k financial data
Total income from all sources	2020-12-31	$928,640
Expenses. Total of all expenses incurred	2020-12-31	$120,488
Benefits paid (including direct rollovers)	2020-12-31	$69,791
Total plan assets at end of year	2020-12-31	$7,443,907
Total plan assets at beginning of year	2020-12-31	$6,635,755
Value of fidelity bond covering the plan	2020-12-31	$1,400,000
Total contributions received or receivable from participants	2020-12-31	$107,491
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$718,624
Net income (gross income less expenses)	2020-12-31	$808,152
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$7,443,907
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$6,635,755
Assets. Value of assets in partnership/joint-venture interests	2020-12-31	$1,139,366
Total contributions received or receivable from employer(s)	2020-12-31	$102,525
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$50,697
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$1,034,735
Expenses. Total of all expenses incurred	2019-12-31	$267,835
Benefits paid (including direct rollovers)	2019-12-31	$218,199
Total plan assets at end of year	2019-12-31	$6,635,755
Total plan assets at beginning of year	2019-12-31	$5,868,855
Value of fidelity bond covering the plan	2019-12-31	$1,400,000
Total contributions received or receivable from participants	2019-12-31	$101,707
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$22,785
Other income received	2019-12-31	$857,905
Net income (gross income less expenses)	2019-12-31	$766,900
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$6,635,755
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$5,868,855
Assets. Value of assets in partnership/joint-venture interests	2019-12-31	$978,380
Total contributions received or receivable from employer(s)	2019-12-31	$52,338
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$49,636
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$87,258
Expenses. Total of all expenses incurred	2018-12-31	$245,210
Benefits paid (including direct rollovers)	2018-12-31	$200,448
Total plan assets at end of year	2018-12-31	$5,868,855
Total plan assets at beginning of year	2018-12-31	$6,026,807
Value of fidelity bond covering the plan	2018-12-31	$1,400,000
Total contributions received or receivable from participants	2018-12-31	$99,606
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$-113,619
Net income (gross income less expenses)	2018-12-31	$-157,952
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$5,868,855
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$6,026,807
Assets. Value of assets in partnership/joint-venture interests	2018-12-31	$789,352
Total contributions received or receivable from employer(s)	2018-12-31	$101,271
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$44,762
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$778,936
Expenses. Total of all expenses incurred	2017-12-31	$799,925
Benefits paid (including direct rollovers)	2017-12-31	$788,291
Total plan assets at end of year	2017-12-31	$6,026,807
Total plan assets at beginning of year	2017-12-31	$6,047,796
Value of fidelity bond covering the plan	2017-12-31	$1,400,000
Total contributions received or receivable from participants	2017-12-31	$97,915
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$621,266
Net income (gross income less expenses)	2017-12-31	$-20,989
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$6,026,807
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$6,047,796
Assets. Value of assets in partnership/joint-venture interests	2017-12-31	$875,513
Total contributions received or receivable from employer(s)	2017-12-31	$59,755
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$11,634
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$655,393
Expenses. Total of all expenses incurred	2016-12-31	$322,019
Benefits paid (including direct rollovers)	2016-12-31	$291,691
Total plan assets at end of year	2016-12-31	$6,047,796
Total plan assets at beginning of year	2016-12-31	$5,714,422
Value of fidelity bond covering the plan	2016-12-31	$1,400,000
Total contributions received or receivable from participants	2016-12-31	$77,279
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$3,621
Other income received	2016-12-31	$522,238
Net income (gross income less expenses)	2016-12-31	$333,374
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$6,047,796
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$5,714,422
Assets. Value of assets in partnership/joint-venture interests	2016-12-31	$844,632
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2016-12-31	$24,000
Total contributions received or receivable from employer(s)	2016-12-31	$52,255
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$30,328
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$13,221
Expenses. Total of all expenses incurred	2015-12-31	$293,616
Benefits paid (including direct rollovers)	2015-12-31	$263,495
Total plan assets at end of year	2015-12-31	$5,714,422
Total plan assets at beginning of year	2015-12-31	$5,994,817
Value of fidelity bond covering the plan	2015-12-31	$1,400,000
Total contributions received or receivable from participants	2015-12-31	$69,008
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$47,069
Other income received	2015-12-31	$-141,356
Net income (gross income less expenses)	2015-12-31	$-280,395
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$5,714,422
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$5,994,817
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$773,797
Total contributions received or receivable from employer(s)	2015-12-31	$38,500
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$30,121
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$304,873
Expenses. Total of all expenses incurred	2014-12-31	$149,660
Benefits paid (including direct rollovers)	2014-12-31	$145,327
Total plan assets at end of year	2014-12-31	$5,994,817
Total plan assets at beginning of year	2014-12-31	$5,839,604
Value of fidelity bond covering the plan	2014-12-31	$1,400,000
Total contributions received or receivable from participants	2014-12-31	$50,127
Expenses. Other expenses not covered elsewhere	2014-12-31	$4,333
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$217,550
Net income (gross income less expenses)	2014-12-31	$155,213
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$5,994,817
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$5,839,604
Assets. Value of participant loans	2014-12-31	$2,178
Assets. Value of assets in partnership/joint-venture interests	2014-12-31	$823,420
Total contributions received or receivable from employer(s)	2014-12-31	$37,196
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$852,949
Expenses. Total of all expenses incurred	2013-12-31	$112,048
Benefits paid (including direct rollovers)	2013-12-31	$108,130
Total plan assets at end of year	2013-12-31	$5,839,604
Total plan assets at beginning of year	2013-12-31	$5,098,703
Value of fidelity bond covering the plan	2013-12-31	$1,400,000
Total contributions received or receivable from participants	2013-12-31	$62,764
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$753,162
Net income (gross income less expenses)	2013-12-31	$740,901
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$5,839,604
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$5,098,703
Assets. Value of participant loans	2013-12-31	$5,178
Assets. Value of assets in partnership/joint-venture interests	2013-12-31	$815,557
Total contributions received or receivable from employer(s)	2013-12-31	$37,023
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$3,918
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$547,276
Expenses. Total of all expenses incurred	2012-12-31	$86,639
Benefits paid (including direct rollovers)	2012-12-31	$79,184
Total plan assets at end of year	2012-12-31	$5,098,703
Total plan assets at beginning of year	2012-12-31	$4,638,066
Value of fidelity bond covering the plan	2012-12-31	$1,400,000
Total contributions received or receivable from participants	2012-12-31	$49,155
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$462,000
Net income (gross income less expenses)	2012-12-31	$460,637
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$5,098,703
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$4,638,066
Assets. Value of participant loans	2012-12-31	$8,027
Assets. Value of assets in partnership/joint-venture interests	2012-12-31	$625,792
Total contributions received or receivable from employer(s)	2012-12-31	$36,121
Value of certain deemed distributions of participant loans	2012-12-31	$2,080
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$5,375
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$-72,011
Expenses. Total of all expenses incurred	2011-12-31	$89,770
Benefits paid (including direct rollovers)	2011-12-31	$80,868
Total plan assets at end of year	2011-12-31	$4,638,066
Total plan assets at beginning of year	2011-12-31	$4,799,847
Value of fidelity bond covering the plan	2011-12-31	$1,400,000
Total contributions received or receivable from participants	2011-12-31	$45,811
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-154,241
Net income (gross income less expenses)	2011-12-31	$-161,781
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$4,638,066
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$4,799,847
Assets. Value of participant loans	2011-12-31	$20,060
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$569,428
Total contributions received or receivable from employer(s)	2011-12-31	$36,419
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$8,902
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$508,922
Expenses. Total of all expenses incurred	2010-12-31	$37,296
Benefits paid (including direct rollovers)	2010-12-31	$9,519
Total plan assets at end of year	2010-12-31	$4,799,847
Total plan assets at beginning of year	2010-12-31	$4,328,221
Value of fidelity bond covering the plan	2010-12-31	$1,400,000
Total contributions received or receivable from participants	2010-12-31	$46,496
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$426,160
Net income (gross income less expenses)	2010-12-31	$471,626
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$4,799,847
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$4,328,221
Assets. Value of participant loans	2010-12-31	$29,597
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$614,782
Total contributions received or receivable from employer(s)	2010-12-31	$36,266
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$27,777
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN

2020: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: RICHARD D FEWELL, DDS, MS AND CHRISTOPHER P. FOGARTY, DMD, MS, PC 401(K) CROSS TESTED PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
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

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

64399

Policy instance

Insurance contract or identification number	64399
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,313
Total amount of fees paid to insurance company	USD $645
Commission paid to Insurance Broker	USD $8,313
Amount paid for insurance broker fees	0
Insurance broker organization code?	4
Additional information about fees paid to insurance broker	TPA FEES PAID AND COMPESATION
Insurance broker name	EMPLOYEE BENEFIT SERVICES, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

64399

Policy instance

Insurance contract or identification number	64399
Number of Individuals Covered	29
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $10,723
Total amount of fees paid to insurance company	USD $766
Commission paid to Insurance Broker	USD $10,723
Amount paid for insurance broker fees	0
Insurance broker organization code?	4
Additional information about fees paid to insurance broker	TPA FEES PAID & COMPENSATION
Insurance broker name	EMPLOYEE BENEFIT SERVICES, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

64399

Policy instance

Insurance contract or identification number	64399
Number of Individuals Covered	27
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,262
Total amount of fees paid to insurance company	USD $542
Commission paid to Insurance Broker	USD $9,262
Amount paid for insurance broker fees	0
Insurance broker organization code?	4
Additional information about fees paid to insurance broker	TPA FEES PAID AND COMPENSATION
Insurance broker name	EMPLOYEE BENEFIT SERVICES, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

64399

Policy instance

Insurance contract or identification number	64399
Number of Individuals Covered	26
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,641
Total amount of fees paid to insurance company	USD $692
Commission paid to Insurance Broker	USD $7,641
Amount paid for insurance broker fees	0
Insurance broker organization code?	4
Additional information about fees paid to insurance broker	TPA FEES PAID AND COMPENSATION
Insurance broker name	EMPLOYEE BENEFIT SERVICES, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

64399

Policy instance

Insurance contract or identification number	64399
Number of Individuals Covered	26
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $6,129
Total amount of fees paid to insurance company	USD $497
Commission paid to Insurance Broker	USD $6,129
Amount paid for insurance broker fees	0
Insurance broker organization code?	4
Additional information about fees paid to insurance broker	TPA COMPENSATION & FEES PAID
Insurance broker name	EMPLOYEE BENEFIT SERVICES, INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

64399

Policy instance

Insurance contract or identification number	64399
Number of Individuals Covered	25
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,761
Total amount of fees paid to insurance company	USD $481

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

64399

Policy instance

Insurance contract or identification number	64399
Number of Individuals Covered	26
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,851
Total amount of fees paid to insurance company	USD $194
Commission paid to Insurance Broker	USD $4,851
Amount paid for insurance broker fees	0
Insurance broker organization code?	4
Additional information about fees paid to insurance broker	TPA COMPENSATION
Insurance broker name	EMPLOYEE BENEFIT SERVICES, INC.

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Company Name:	RICHARD D. FEWELL DDS, MS AND CHRISTOPHER P. FOGARTY DMD, MS, PC
Employer identification number (EIN):	621033680
NAIC Classification:	621210
NAIC Description:	Offices of Dentists