401k Plan data: DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST plan

DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST 401k Plan overview

Plan Name	DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST
Plan identification number	100

DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

DR. DONALD A. HOLLSTEN has sponsored the creation of one or more 401k plans.

Company Name: DR. DONALD A. HOLLSTEN

Employer identification number (EIN): 742702283

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
100 2011-01-01 DR DONALD A HOLLSTEN
100 2009-01-01 DR DONALD A HOLLSTEN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
100	2011-01-01	DR DONALD A HOLLSTEN
100	2009-01-01	DR DONALD A HOLLSTEN

Plan Statistics for DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST

401k plan membership statisitcs for DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST

Measure Date Value
2011: DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 8
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 9
Total participants 2011-01-01 9
Number of participants with account balances 2011-01-01 9
2009: DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST 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 7
Total of all active and inactive participants 2009-01-01 7
Total participants 2009-01-01 7
Number of participants with account balances 2009-01-01 7

Measure	Date	Value
2011: DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	8
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	9
Total participants	2011-01-01	9
Number of participants with account balances	2011-01-01	9
2009: DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST 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	7
Total of all active and inactive participants	2009-01-01	7
Total participants	2009-01-01	7
Number of participants with account balances	2009-01-01	7

Financial Data on DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST

Measure	Date	Value
2011 : DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST 2011 401k financial data
Total income from all sources	2011-12-31	$-1,157
Expenses. Total of all expenses incurred	2011-12-31	$16,860
Total plan assets at end of year	2011-12-31	$742,908
Total plan assets at beginning of year	2011-12-31	$760,925
Expenses. Other expenses not covered elsewhere	2011-12-31	$16,860
Other income received	2011-12-31	$-44,445
Net income (gross income less expenses)	2011-12-31	$-18,017
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$742,908
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$760,925
Total contributions received or receivable from employer(s)	2011-12-31	$43,288
2010 : DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST 2010 401k financial data
Total income from all sources	2010-12-31	$154,642
Expenses. Total of all expenses incurred	2010-12-31	$14,084
Total plan assets at end of year	2010-12-31	$760,925
Total plan assets at beginning of year	2010-12-31	$620,367
Expenses. Other expenses not covered elsewhere	2010-12-31	$14,084
Other income received	2010-12-31	$73,941
Net income (gross income less expenses)	2010-12-31	$140,558
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$760,925
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$620,367
Total contributions received or receivable from employer(s)	2010-12-31	$80,701

Form 5500 Responses for DR. DONALD A. HOLLSTEN 401 K PLAN & TRUST

2011: DR. DONALD A. HOLLSTEN 401 K 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: DR. DONALD A. HOLLSTEN 401 K 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:	DR. DONALD A. HOLLSTEN
Employer identification number (EIN):	742702283
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)