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| Plan Name | NORTHWEST EYE & LASER CENTER 401(K) PROFIT SHARING PLAN |
| Plan identification number | 001 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
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| Company Name: | NORTHWEST EYE & LASER CENTER |
| Employer identification number (EIN): | 820519838 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 001 | 2010-01-01 | MARK J. BOERNER | |||
| 001 | 2009-01-01 | MARK J. BOERNER, M.D. | MARK J. BOERNER, M.D. | 2010-05-20 |
| Measure | Date | Value |
|---|---|---|
| 2010: NORTHWEST EYE & LASER CENTER 401(K) PROFIT SHARING PLAN 2010 401k membership | ||
| Total participants, beginning-of-year | 2010-01-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 0 |
| Number of participants with account balances | 2010-01-01 | 0 |
| 2009: NORTHWEST EYE & LASER CENTER 401(K) PROFIT SHARING PLAN 2009 401k membership | ||
| Total participants, beginning-of-year | 2009-01-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 6 |
| 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 | 7 |
| Total participants | 2009-01-01 | 7 |
| Number of participants with account balances | 2009-01-01 | 7 |
| Measure | Date | Value |
|---|---|---|
| 2010 : NORTHWEST EYE & LASER CENTER 401(K) PROFIT SHARING PLAN 2010 401k financial data | ||
| Total income from all sources | 2010-08-09 | $53,511 |
| Expenses. Total of all expenses incurred | 2010-08-09 | $725,619 |
| Benefits paid (including direct rollovers) | 2010-08-09 | $725,619 |
| Total plan assets at beginning of year | 2010-08-09 | $672,108 |
| Value of fidelity bond covering the plan | 2010-08-09 | $65,000 |
| Other income received | 2010-08-09 | $53,511 |
| Net income (gross income less expenses) | 2010-08-09 | $-672,108 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-08-09 | $672,108 |
| 2010: NORTHWEST EYE & LASER CENTER 401(K) PROFIT SHARING PLAN 2010 form 5500 responses | ||
|---|---|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | This submission is the final filing | Yes |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: NORTHWEST EYE & LASER CENTER 401(K) PROFIT SHARING PLAN 2009 form 5500 responses | ||
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
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