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| Plan Name | HAROLD H. ROSEN, M.D. PROFIT SHARING PLAN |
| Plan identification number | 002 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
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| Company Name: | HAROLD H. ROSEN, M.D., P.A. |
| Employer identification number (EIN): | 650085794 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
Additional information about HAROLD H. ROSEN, M.D., P.A.
| Jurisdiction of Incorporation: | Florida Department of State Division of Corporations |
| Incorporation Date: | 1988-11-21 |
| Company Identification Number: | K46373 |
| Legal Registered Office Address: |
4000 HOLLYWOOD BLVD STE 485 HOLLYWOOD 00000 |
More information about HAROLD H. ROSEN, M.D., P.A.
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 002 | 2011-01-01 | CAMERON KELLY | 2012-02-14 | ||
| 002 | 2010-01-01 | CAMERON KELLY | 2011-12-28 | ||
| 002 | 2008-01-01 | CAMERON KELLY |
| Measure | Date | Value |
|---|---|---|
| 2008: HAROLD H. ROSEN, M.D. PROFIT SHARING PLAN 2008 401k membership | ||
| Total participants, beginning-of-year | 2008-01-01 | 7 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-01-01 | 5 |
| 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 | 2 |
| 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 | 4 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2008-01-01 | 0 |
| Measure | Date | Value |
|---|---|---|
| 2008 : HAROLD H. ROSEN, M.D. PROFIT SHARING PLAN 2008 401k financial data | ||
| Transfers to/from the plan | 2008-12-31 | $0 |
| Total plan liabilities at end of year | 2008-12-31 | $0 |
| Total plan liabilities at beginning of year | 2008-12-31 | $0 |
| Total income from all sources | 2008-12-31 | $-634,194 |
| Expenses. Total of all expenses incurred | 2008-12-31 | $30 |
| Benefits paid (including direct rollovers) | 2008-12-31 | $0 |
| Total plan assets at end of year | 2008-12-31 | $1,172,987 |
| Total plan assets at beginning of year | 2008-12-31 | $1,807,211 |
| Value of fidelity bond covering the plan | 2008-12-31 | $240,000 |
| Total contributions received or receivable from participants | 2008-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2008-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2008-12-31 | $0 |
| Other income received | 2008-12-31 | $-634,194 |
| Noncash contributions received | 2008-12-31 | $0 |
| Net income (gross income less expenses) | 2008-12-31 | $-634,224 |
| Net plan assets at end of year (total assets less liabilities) | 2008-12-31 | $1,172,987 |
| Net plan assets at beginning of year (total assets less liabilities) | 2008-12-31 | $1,807,211 |
| Total contributions received or receivable from employer(s) | 2008-12-31 | $0 |
| Value of certain deemed distributions of participant loans | 2008-12-31 | $0 |
| Value of corrective distributions | 2008-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2008-12-31 | $30 |
| 2008: HAROLD H. ROSEN, M.D. PROFIT SHARING PLAN 2008 form 5500 responses | ||
|---|---|---|
| 2008-01-01 | Type of plan entity | Single employer plan |
| 2008-01-01 | Submission has been amended | No |
| 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 funding arrangement – Trust | Yes |
| 2008-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2008-01-01 | Plan benefit arrangement - Trust | Yes |
| PRUDENTIAL (National Association of Insurance Commissioners NAIC id number: 86630 ) | |||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 292862 | ||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||
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| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) | |||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | VR02029790 | ||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||
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| AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 ) | |||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 303-731-651 | ||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||||||||||
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