401k Plan data: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN plan

CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 401k Plan overview

Plan Name	CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN
Plan identification number	002

CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN Benefits

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

CAPITAL CITY DENTAL LAB, INC. has sponsored the creation of one or more 401k plans.

Company Name: CAPITAL CITY DENTAL LAB, INC.

Employer identification number (EIN): 931078007

NAIC Classification: 812190

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2013-01-01
002 2012-01-01 MORRIS VATERLAUS
002 2011-01-01 MORRIS VATERLAUS
002 2010-01-01 MORRIS VATERLAUS
002 2009-01-01 MORRIS VATERLAUS

Plan Statistics for CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN

401k plan membership statisitcs for CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN

Measure Date Value
2013: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1
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: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 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 1
Number of retired or separated participants receiving benefits 2012-01-01 1
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 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 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 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 2
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 2
Number of participants with account balances 2010-01-01 1
2009: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 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 1

Measure	Date	Value
2013: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1
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: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 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	1
Number of retired or separated participants receiving benefits	2012-01-01	1
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	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 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	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	2
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	2
Number of participants with account balances	2010-01-01	1
2009: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 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	1

Financial Data on CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN

Measure	Date	Value
2013 : CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$3,915
Expenses. Total of all expenses incurred	2013-12-31	$88,075
Benefits paid (including direct rollovers)	2013-12-31	$87,725
Total plan assets at end of year	2013-12-31	$0
Total plan assets at beginning of year	2013-12-31	$84,160
Value of fidelity bond covering the plan	2013-12-31	$75,000
Expenses. Other expenses not covered elsewhere	2013-12-31	$350
Other income received	2013-12-31	$3,915
Net income (gross income less expenses)	2013-12-31	$-84,160
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$84,160
2012 : CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$1,092
Total plan assets at end of year	2012-12-31	$84,160
Total plan assets at beginning of year	2012-12-31	$83,068
Value of fidelity bond covering the plan	2012-12-31	$75,000
Other income received	2012-12-31	$1,092
Net income (gross income less expenses)	2012-12-31	$1,092
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$84,160
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$83,068
2011 : CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$-5,848
Total plan assets at end of year	2011-12-31	$83,068
Total plan assets at beginning of year	2011-12-31	$88,916
Value of fidelity bond covering the plan	2011-12-31	$75,000
Other income received	2011-12-31	$-5,848
Net income (gross income less expenses)	2011-12-31	$-5,848
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$83,068
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$88,916
2010 : CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$3,617
Total plan assets at end of year	2010-12-31	$88,916
Total plan assets at beginning of year	2010-12-31	$85,299
Value of fidelity bond covering the plan	2010-12-31	$75,000
Other income received	2010-12-31	$3,617
Net income (gross income less expenses)	2010-12-31	$3,617
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$88,916
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$85,299

Form 5500 Responses for CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN

2013: CAPITAL CITY DENTAL LAB INC PROFIT SHARING 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	Yes
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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 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: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 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
2010: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: CAPITAL CITY DENTAL LAB INC PROFIT SHARING PLAN 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:	CAPITAL CITY DENTAL LAB, INC.
Employer identification number (EIN):	931078007
NAIC Classification:	812190

Plan id#	Filing Submission Date	Name of Administrator
002	2013-01-01
002	2012-01-01	MORRIS VATERLAUS
002	2011-01-01	MORRIS VATERLAUS
002	2010-01-01	MORRIS VATERLAUS
002	2009-01-01	MORRIS VATERLAUS