401k Plan data: DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST plan

DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST
Plan identification number	001

DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER has sponsored the creation of one or more 401k plans.

Company Name: DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER

Employer identification number (EIN): 133553483

NAIC Classification: 621340
NAIC Description: Offices of Physical, Occupational and Speech Therapists, and Audiologists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01
001 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01 DAWN UTSTEIN 2016-09-09
001 2014-01-01 DAWN UTSTEIN 2015-08-24
001 2013-01-01 DAWN UTSTEIN 2014-08-11
001 2012-01-01 DAWN UTSTEIN 2013-07-26 DAWN UTSTEIN 2013-07-26
001 2011-01-01 DAWN UTSTEIN 2012-09-24
001 2010-01-01 DAWN UTSTEIN
001 2009-01-01 MARILYN UTSTEIN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2019-01-01
001	2018-01-01
001	2017-01-01
001	2016-01-01
001	2015-01-01	DAWN UTSTEIN	2016-09-09
001	2014-01-01	DAWN UTSTEIN	2015-08-24
001	2013-01-01	DAWN UTSTEIN	2014-08-11
001	2012-01-01	DAWN UTSTEIN	2013-07-26	DAWN UTSTEIN	2013-07-26
001	2011-01-01	DAWN UTSTEIN	2012-09-24
001	2010-01-01	DAWN UTSTEIN
001	2009-01-01	MARILYN UTSTEIN

Plan Statistics for DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST

Measure Date Value
2010: DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 24
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 14
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 9
Total of all active and inactive participants 2010-01-01 23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 23
Number of participants with account balances 2010-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 25
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 14
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 10
Total of all active and inactive participants 2009-01-01 24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 24
Number of participants with account balances 2009-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2010: DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	24
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	14
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	9
Total of all active and inactive participants	2010-01-01	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	23
Number of participants with account balances	2010-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	25
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	14
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	10
Total of all active and inactive participants	2009-01-01	24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	24
Number of participants with account balances	2009-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST

Measure	Date	Value
2010 : DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$198,234
Expenses. Total of all expenses incurred	2010-12-31	$19,853
Benefits paid (including direct rollovers)	2010-12-31	$19,705
Total plan assets at end of year	2010-12-31	$1,187,786
Total plan assets at beginning of year	2010-12-31	$1,009,405
Value of fidelity bond covering the plan	2010-12-31	$100,000
Total contributions received or receivable from participants	2010-12-31	$89,879
Expenses. Other expenses not covered elsewhere	2010-12-31	$148
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$108,355
Net income (gross income less expenses)	2010-12-31	$178,381
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,187,786
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,009,405
Assets. Value of participant loans	2010-12-31	$82,010
Total contributions received or receivable from employer(s)	2010-12-31	$0
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
2009 : DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST

2010: DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER 401(K) PROFIT SHARING PLAN & TRUST 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 – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-806709

Policy instance

Insurance contract or identification number	GA-806709
Number of Individuals Covered	23
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,829
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?	Yes
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 $3,829
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY

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Company Name:	DAWN UTSTEIN P.T. P.C. PHYSIO SPORTS CENTER
Employer identification number (EIN):	133553483
NAIC Classification:	621340
NAIC Description:	Offices of Physical, Occupational and Speech Therapists, and Audiologists