PAUL M. PETELIN, M.D., F.A.C.S., LTD. DEFINED BENEFIT PENSION PLAN 401k Plan overview

PAUL M. PETELIN, M.D., F.A.C.S., LTD. DEFINED BENEFIT PENSION PLAN Benefits

401k Sponsoring company profile

Company Name:	PAUL M. PETELIN, M.D., F.A.C.S., LTD.
Employer identification number (EIN):	860810032
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2010-01-01	LARRY BUTCHER PREPARER	2011-10-10
001	2009-01-01			PAUL PETELIN	2010-10-07

Plan Statistics for PAUL M. PETELIN, M.D., F.A.C.S., LTD. DEFINED BENEFIT PENSION PLAN

Measure	Date	Value
2009: PAUL M. PETELIN, M.D., F.A.C.S., LTD. DEFINED BENEFIT PENSION PLAN 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	3
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	1
Total of all active and inactive participants	2009-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Form 5500 Responses for PAUL M. PETELIN, M.D., F.A.C.S., LTD. DEFINED BENEFIT PENSION PLAN

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