401k Plan data: DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN plan

DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN
Plan identification number	001

DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN 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.
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

DONATO J ARGUELLES, M.D., P.A has sponsored the creation of one or more 401k plans.

Company Name: DONATO J ARGUELLES, M.D., P.A

Employer identification number (EIN): 650048002

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 DONATO J ARGUELLES 2014-10-09 DONATO J ARGUELLES 2014-10-09
001 2012-01-01 DONATO J ARGUELLES 2013-10-10
001 2011-01-01 DONATO J ARGUELLES 2012-10-04
001 2009-01-01 MARIA ARGUELLES
001 2008-01-01 MARIA ARGUELLES

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2013-01-01	DONATO J ARGUELLES	2014-10-09	DONATO J ARGUELLES	2014-10-09
001	2012-01-01	DONATO J ARGUELLES	2013-10-10
001	2011-01-01	DONATO J ARGUELLES	2012-10-04
001	2009-01-01	MARIA ARGUELLES
001	2008-01-01	MARIA ARGUELLES

Plan Statistics for DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN

Measure Date Value
2009: DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 6
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 1
Total of all active and inactive participants 2009-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 7
Number of participants with account balances 2009-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0
2008: DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 6
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 1
Total of all active and inactive participants 2008-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2008-01-01 0
Total participants 2008-01-01 7
Number of participants with account balances 2008-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2008-01-01 0

Measure	Date	Value
2009: DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	6
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	1
Total of all active and inactive participants	2009-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	7
Number of participants with account balances	2009-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0
2008: DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	6
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	1
Total of all active and inactive participants	2008-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2008-01-01	0
Total participants	2008-01-01	7
Number of participants with account balances	2008-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2008-01-01	0

Financial Data on DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2010 : DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$17,709
Expenses. Total of all expenses incurred	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$106,023
Total plan assets at beginning of year	2010-12-31	$88,314
Total contributions received or receivable from participants	2010-12-31	$6,542
Other income received	2010-12-31	$9,361
Net income (gross income less expenses)	2010-12-31	$17,709
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$106,023
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$88,314
Total contributions received or receivable from employer(s)	2010-12-31	$1,806
2008 : DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN 2008 401k financial data
Total income from all sources	2008-12-31	$-26,211
Expenses. Total of all expenses incurred	2008-12-31	$0
Total plan assets at end of year	2008-12-31	$55,508
Total plan assets at beginning of year	2008-12-31	$81,719
Total contributions received or receivable from participants	2008-12-31	$6,053
Other income received	2008-12-31	$-37,106
Net income (gross income less expenses)	2008-12-31	$-26,211
Net plan assets at end of year (total assets less liabilities)	2008-12-31	$55,508
Net plan assets at beginning of year (total assets less liabilities)	2008-12-31	$81,719
Total contributions received or receivable from employer(s)	2008-12-31	$4,842

Form 5500 Responses for DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN

2009: DONATO J ARGUELLES, M.D., P.A. 401(K) 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 – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2008: DONATO J ARGUELLES, M.D., P.A. 401(K) PROFIT SHARING PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	Yes
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-54-CH13

Policy instance

Insurance contract or identification number	GAP-54-CH13
Number of Individuals Covered	7
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $892
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
Commission paid to Insurance Broker	USD $892
Additional information about fees paid to insurance broker	0
Insurance broker organization code?	4
Insurance broker name	UBS FINANCIAL SERVICES, INC.

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

GAP-54-CH13

Policy instance

Insurance contract or identification number	GAP-54-CH13
Number of Individuals Covered	5
Insurance policy start date	2008-01-01
Insurance policy end date	2008-12-31
Total amount of commissions paid to insurance broker	USD $675
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
Commission paid to Insurance Broker	USD $675
Insurance broker organization code?	4
Insurance broker name	UBS FINANCIAL SERVICES, INC.

Potentially related plans

DONATO J. STINGHEN, M.D., INC. PS PLAN [EIN = 942749830]

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Company Name:	DONATO J ARGUELLES, M.D., P.A
Employer identification number (EIN):	650048002
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)