401k Plan data: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST plan

JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST
Plan identification number	001

JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST Benefits

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

401k Sponsoring company profile

JOSE L. PABILONA M.D. has sponsored the creation of one or more 401k plans.

Company Name: JOSE L. PABILONA M.D.

Employer identification number (EIN): 731264729

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 JOSE PABILONA JOSE PABILONA 2013-06-22
001 2012-01-01 JOSE PABILONA JOSE PABILONA 2013-06-06
001 2011-01-01 JOSE PABILONA JOSE PABILONA 2012-07-09
001 2009-01-01 JOSE L. PABILONA JOSE L. PABILONA 2010-07-16

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2013-01-01	JOSE PABILONA	JOSE PABILONA	2013-06-22
001	2012-01-01	JOSE PABILONA	JOSE PABILONA	2013-06-06
001	2011-01-01	JOSE PABILONA	JOSE PABILONA	2012-07-09
001	2009-01-01	JOSE L. PABILONA	JOSE L. PABILONA	2010-07-16

Plan Statistics for JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST

Measure Date Value
2013: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 2
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: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2
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 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 2
Number of participants with account balances 2012-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 2
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 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 2
Number of participants with account balances 2011-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2
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 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 2
Number of participants with account balances 2009-01-01 2

Measure	Date	Value
2013: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2
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: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2
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	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	2
Number of participants with account balances	2012-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2
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	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	2
Number of participants with account balances	2011-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2
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	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	2
Number of participants with account balances	2009-01-01	2

Financial Data on JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST

Measure	Date	Value
2013 : JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2013 401k financial data
Total income from all sources	2013-05-31	$0
Expenses. Total of all expenses incurred	2013-05-31	$541,463
Benefits paid (including direct rollovers)	2013-05-31	$541,463
Total plan assets at end of year	2013-05-31	$0
Total plan assets at beginning of year	2013-05-31	$541,463
Net income (gross income less expenses)	2013-05-31	$-541,463
Net plan assets at end of year (total assets less liabilities)	2013-05-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2013-05-31	$541,463
2012 : JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2012 401k financial data
Total income from all sources	2012-12-31	$58,983
Expenses. Total of all expenses incurred	2012-12-31	$20,335
Benefits paid (including direct rollovers)	2012-12-31	$20,335
Total plan assets at end of year	2012-12-31	$541,463
Total plan assets at beginning of year	2012-12-31	$502,815
Other income received	2012-12-31	$58,983
Net income (gross income less expenses)	2012-12-31	$38,648
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$541,463
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$502,815
2011 : JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2011 401k financial data
Total income from all sources	2011-12-31	$-44,141
Expenses. Total of all expenses incurred	2011-12-31	$21,000
Benefits paid (including direct rollovers)	2011-12-31	$21,000
Total plan assets at end of year	2011-12-31	$502,815
Total plan assets at beginning of year	2011-12-31	$567,956
Other income received	2011-12-31	$-44,141
Net income (gross income less expenses)	2011-12-31	$-65,141
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$502,815
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$567,956
2010 : JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 2010 401k financial data
Total income from all sources	2010-12-31	$81,375
Expenses. Total of all expenses incurred	2010-12-31	$22,069
Benefits paid (including direct rollovers)	2010-12-31	$22,069
Total plan assets at end of year	2010-12-31	$567,956
Total plan assets at beginning of year	2010-12-31	$508,650
Other income received	2010-12-31	$71,375
Net income (gross income less expenses)	2010-12-31	$59,306
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$567,956
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$508,650
Total contributions received or receivable from employer(s)	2010-12-31	$10,000

Form 5500 Responses for JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST

2013: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 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	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 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: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 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: JOSE L. PABILONA M.D. PROFIT SHARING PLAN & TRUST 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:	JOSE L. PABILONA M.D.
Employer identification number (EIN):	731264729
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)