401k Plan data: IVERSON EYECARE DEFINED BENEFIT PENSION PLAN plan

IVERSON EYECARE DEFINED BENEFIT PENSION PLAN 401k Plan overview

Plan Name	IVERSON EYECARE DEFINED BENEFIT PENSION PLAN
Plan identification number	002

IVERSON EYECARE DEFINED BENEFIT PENSION PLAN Benefits

401k Plan Type	Defined Benefit Pension
Plan Features/Benefits	Benefits are primarily pay related

401k Sponsoring company profile

IVERSON EYECARE has sponsored the creation of one or more 401k plans.

Company Name: IVERSON EYECARE

Employer identification number (EIN): 030306366

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IVERSON EYECARE DEFINED BENEFIT PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01
002 2015-01-01
002 2014-01-01 MARK IVERSON 2015-09-01
002 2013-01-01 MARK IVERSON 2014-10-01
002 2012-01-01 MARK IVERSON 2013-09-26
002 2011-01-01 MARK IVERSON
002 2009-01-01 MARK IVERSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2016-01-01
002	2015-01-01
002	2014-01-01	MARK IVERSON	2015-09-01
002	2013-01-01	MARK IVERSON	2014-10-01
002	2012-01-01	MARK IVERSON	2013-09-26
002	2011-01-01	MARK IVERSON
002	2009-01-01	MARK IVERSON

Plan Statistics for IVERSON EYECARE DEFINED BENEFIT PENSION PLAN

401k plan membership statisitcs for IVERSON EYECARE DEFINED BENEFIT PENSION PLAN

Measure Date Value
2011: IVERSON EYECARE DEFINED BENEFIT PENSION 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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: IVERSON EYECARE DEFINED BENEFIT PENSION 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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: IVERSON EYECARE DEFINED BENEFIT PENSION 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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: IVERSON EYECARE DEFINED BENEFIT PENSION 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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on IVERSON EYECARE DEFINED BENEFIT PENSION PLAN

Measure	Date	Value
2011 : IVERSON EYECARE DEFINED BENEFIT PENSION PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$65,782
Expenses. Total of all expenses incurred	2011-12-31	$0
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$240,591
Total plan assets at beginning of year	2011-12-31	$174,809
Value of fidelity bond covering the plan	2011-12-31	$40,000
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-10,787
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$65,782
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$240,591
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$174,809
Total contributions received or receivable from employer(s)	2011-12-31	$76,569
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : IVERSON EYECARE DEFINED BENEFIT PENSION PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
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	$63,410
Expenses. Total of all expenses incurred	2010-12-31	$0
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$174,809
Total plan assets at beginning of year	2010-12-31	$111,399
Value of fidelity bond covering the plan	2010-12-31	$40,000
Total contributions received or receivable from participants	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$6,386
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$63,410
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$174,809
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$111,399
Total contributions received or receivable from employer(s)	2010-12-31	$57,024
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	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : IVERSON EYECARE DEFINED BENEFIT PENSION PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for IVERSON EYECARE DEFINED BENEFIT PENSION PLAN

2011: IVERSON EYECARE DEFINED BENEFIT PENSION PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: IVERSON EYECARE DEFINED BENEFIT PENSION 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:	IVERSON EYECARE
Employer identification number (EIN):	030306366
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)