401k Plan data: PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN plan

PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN 401k Plan overview

Plan Name	PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN
Plan identification number	001

PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all 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.
Participant-directed brokerage accounts provided as an investment option under the plan.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC.

Employer identification number (EIN): 943235612

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 RANDOLPH WONG 2013-01-10 RANDOLPH WONG 2013-01-10
001 2011-01-01 RANDOLPH WONG 2012-08-14 RANDOLPH WONG 2012-08-14
001 2009-01-01 BRENDA ALMES BRENDA ALMES 2010-10-14
001 2009-01-01 BRENDA ALMES BRENDA ALMES 2010-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2012-01-01	RANDOLPH WONG	2013-01-10	RANDOLPH WONG	2013-01-10
001	2011-01-01	RANDOLPH WONG	2012-08-14	RANDOLPH WONG	2012-08-14
001	2009-01-01	BRENDA ALMES		BRENDA ALMES	2010-10-14
001	2009-01-01	BRENDA ALMES		BRENDA ALMES	2010-10-14

Plan Statistics for PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN

401k plan membership statisitcs for PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN

Measure Date Value
2009: PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 43
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 32
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 9
Total of all active and inactive participants 2009-01-01 42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 42
Number of participants with account balances 2009-01-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2009: PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	43
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	32
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	9
Total of all active and inactive participants	2009-01-01	42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	42
Number of participants with account balances	2009-01-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN

Measure	Date	Value
2010 : PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$1,962,391
Expenses. Total of all expenses incurred	2010-12-31	$380,653
Benefits paid (including direct rollovers)	2010-12-31	$364,057
Total plan assets at end of year	2010-12-31	$10,208,919
Total plan assets at beginning of year	2010-12-31	$8,627,181
Value of fidelity bond covering the plan	2010-12-31	$500,000
Total contributions received or receivable from participants	2010-12-31	$39,618
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$1,353,435
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$1,581,738
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$10,208,919
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$8,627,181
Assets. Value of participant loans	2010-12-31	$52,745
Total contributions received or receivable from employer(s)	2010-12-31	$569,338
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$16,596

Form 5500 Responses for PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN

2009: PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC. 401K PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	PENINSULA SURGICAL SPECIALISTS MEDICAL GROUP, INC.
Employer identification number (EIN):	943235612
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)