401k Plan data: FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN plan

FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 401k Plan overview

Plan Name	FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN
Plan identification number	001

FRANK A. MAROTTA, D.D.S. RETIREMENT 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.
Plan covering Self-Employed individuals.
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

FRANK A. MAROTTA, D.D.S. has sponsored the creation of one or more 401k plans.

Company Name: FRANK A. MAROTTA, D.D.S.

Employer identification number (EIN): 112202399

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 ELIZABETH MAROTTA
001 2014-01-01 ELIZABETH MAROTTA
001 2013-01-01 FRANK MAROTTA
001 2012-01-01 FRANK MAROTTA
001 2011-01-01 FRANK MAROTTA
001 2009-01-01 FRANK MAROTTA

Plan id#	Filing Submission Date	Name of Administrator
001	2015-01-01	ELIZABETH MAROTTA
001	2014-01-01	ELIZABETH MAROTTA
001	2013-01-01	FRANK MAROTTA
001	2012-01-01	FRANK MAROTTA
001	2011-01-01	FRANK MAROTTA
001	2009-01-01	FRANK MAROTTA

Plan Statistics for FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN

401k plan membership statisitcs for FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN

Measure Date Value
2015: FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 2
Number of participants with account balances 2014-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2
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 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 2
Number of participants with account balances 2013-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: FRANK A. MAROTTA, D.D.S. RETIREMENT 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 2
Number of retired or separated participants receiving benefits 2012-01-01 0
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 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: FRANK A. MAROTTA, D.D.S. RETIREMENT 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 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: FRANK A. MAROTTA, D.D.S. RETIREMENT 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 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
2015: FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	2
Number of participants with account balances	2014-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2
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	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	2
Number of participants with account balances	2013-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: FRANK A. MAROTTA, D.D.S. RETIREMENT 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	2
Number of retired or separated participants receiving benefits	2012-01-01	0
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	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: FRANK A. MAROTTA, D.D.S. RETIREMENT 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	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: FRANK A. MAROTTA, D.D.S. RETIREMENT 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	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 FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN

Measure	Date	Value
2015 : FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2015 401k financial data
Transfers to/from the plan	2015-11-03	$0
Total plan liabilities at end of year	2015-11-03	$0
Total plan liabilities at beginning of year	2015-11-03	$0
Total income from all sources	2015-11-03	$-57,631
Expenses. Total of all expenses incurred	2015-11-03	$578,128
Benefits paid (including direct rollovers)	2015-11-03	$573,927
Total plan assets at end of year	2015-11-03	$0
Total plan assets at beginning of year	2015-11-03	$635,759
Value of fidelity bond covering the plan	2015-11-03	$60,000
Total contributions received or receivable from participants	2015-11-03	$625
Expenses. Other expenses not covered elsewhere	2015-11-03	$4,201
Contributions received from other sources (not participants or employers)	2015-11-03	$0
Other income received	2015-11-03	$-58,256
Noncash contributions received	2015-11-03	$0
Net income (gross income less expenses)	2015-11-03	$-635,759
Net plan assets at end of year (total assets less liabilities)	2015-11-03	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-11-03	$635,759
Total contributions received or receivable from employer(s)	2015-11-03	$0
Value of certain deemed distributions of participant loans	2015-11-03	$0
Value of corrective distributions	2015-11-03	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-11-03	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-11-03	$0
2014 : FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$72,118
Expenses. Total of all expenses incurred	2014-12-31	$29,287
Benefits paid (including direct rollovers)	2014-12-31	$22,055
Total plan assets at end of year	2014-12-31	$635,759
Total plan assets at beginning of year	2014-12-31	$592,928
Value of fidelity bond covering the plan	2014-12-31	$60,000
Total contributions received or receivable from participants	2014-12-31	$24,350
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$38,768
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$42,831
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$635,759
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$592,928
Total contributions received or receivable from employer(s)	2014-12-31	$9,000
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$7,232
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$97,640
Expenses. Total of all expenses incurred	2013-12-31	$25,468
Benefits paid (including direct rollovers)	2013-12-31	$18,668
Total plan assets at end of year	2013-12-31	$592,928
Total plan assets at beginning of year	2013-12-31	$520,756
Value of fidelity bond covering the plan	2013-12-31	$60,000
Total contributions received or receivable from participants	2013-12-31	$24,325
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$64,315
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$72,172
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$592,928
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$520,756
Total contributions received or receivable from employer(s)	2013-12-31	$9,000
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$6,800
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$56,063
Expenses. Total of all expenses incurred	2012-12-31	$5,992
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$520,756
Total plan assets at beginning of year	2012-12-31	$470,685
Value of fidelity bond covering the plan	2012-12-31	$60,000
Total contributions received or receivable from participants	2012-12-31	$23,825
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$22,738
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$50,071
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$520,756
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$470,685
Total contributions received or receivable from employer(s)	2012-12-31	$9,500
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$5,992
2011 : FRANK A. MAROTTA, D.D.S. RETIREMENT 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	$13,783
Expenses. Total of all expenses incurred	2011-12-31	$5,055
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$470,685
Total plan assets at beginning of year	2011-12-31	$461,957
Value of fidelity bond covering the plan	2011-12-31	$60,000
Total contributions received or receivable from participants	2011-12-31	$23,325
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	$-19,542
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$8,728
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$470,685
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$461,957
Total contributions received or receivable from employer(s)	2011-12-31	$10,000
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	$5,055
2010 : FRANK A. MAROTTA, D.D.S. RETIREMENT 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	$56,733
Expenses. Total of all expenses incurred	2010-12-31	$6,149
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$461,957
Total plan assets at beginning of year	2010-12-31	$411,373
Value of fidelity bond covering the plan	2010-12-31	$30,000
Total contributions received or receivable from participants	2010-12-31	$17,825
Contributions received from other sources (not participants or employers)	2010-12-31	$770
Other income received	2010-12-31	$22,638
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$50,584
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$461,957
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$411,373
Total contributions received or receivable from employer(s)	2010-12-31	$15,500
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	$6,149

Form 5500 Responses for FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN

2015: FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	Yes
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: FRANK A. MAROTTA, D.D.S. RETIREMENT 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	No
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: FRANK A. MAROTTA, D.D.S. RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: FRANK A. MAROTTA, D.D.S. RETIREMENT 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: FRANK A. MAROTTA, D.D.S. RETIREMENT 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

Insurance Providers Used on plan

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

N208001136

Policy instance

Insurance contract or identification number	N208001136
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $539
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $539
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	SAXONY SECURITIES, INC.

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

N208001136

Policy instance

Insurance contract or identification number	N208001136
Number of Individuals Covered	1
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $489
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $489
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	SAXONY SECURITIES, INC.

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

N208001136

Policy instance

Insurance contract or identification number	N208001136
Number of Individuals Covered	1
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $444
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $444
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	SAXONY SECURITIES, INC.

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

N208001136

Policy instance

Insurance contract or identification number	N208001136
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

N208001136

Policy instance

Insurance contract or identification number	N208001136
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3
Insurance broker name	SAXONY SECURITIES, INC.

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Company Name:	FRANK A. MAROTTA, D.D.S.
Employer identification number (EIN):	112202399
NAIC Classification:	621210
NAIC Description:	Offices of Dentists