401k Plan data: NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN plan

NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN 401k Plan overview

Plan Name	NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN
Plan identification number	001

NORTHSHORE MEDICAL ASSOCIATES 401(K) 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

NORTHSHORE MEDICAL ASSOCIATES has sponsored the creation of one or more 401k plans.

Company Name: NORTHSHORE MEDICAL ASSOCIATES

Employer identification number (EIN): 760314950

NAIC Classification: 621399
NAIC Description: Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 DONALD HEARN 2015-10-15
001 2014-01-01 DONALD HEARN 2015-11-05
001 2013-01-01 DONALD HEARN 2014-10-13
001 2012-01-01 DONALD HEARN 2013-10-15
001 2011-01-01 DONALD HEARN 2012-10-03
001 2010-01-01 DONALD HEARN
001 2009-01-01 LINDA BYRD
001 2009-01-01 LINDA BYRD
001 2009-01-01 LINDA BYRD
001 2009-01-01 LINDA BYRD DONALD HEARN 2010-10-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2014-01-01	DONALD HEARN	2015-10-15
001	2014-01-01	DONALD HEARN	2015-11-05
001	2013-01-01	DONALD HEARN	2014-10-13
001	2012-01-01	DONALD HEARN	2013-10-15
001	2011-01-01	DONALD HEARN	2012-10-03
001	2010-01-01	DONALD HEARN
001	2009-01-01	LINDA BYRD
001	2009-01-01	LINDA BYRD
001	2009-01-01	LINDA BYRD
001	2009-01-01	LINDA BYRD		DONALD HEARN	2010-10-12

Plan Statistics for NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN

401k plan membership statisitcs for NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN

Measure Date Value
2010: NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 7
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 3
Total of all active and inactive participants 2010-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 10
Number of participants with account balances 2010-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 7
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 3
Total of all active and inactive participants 2009-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 10
Number of participants with account balances 2009-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2010: NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	7
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	3
Total of all active and inactive participants	2010-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	10
Number of participants with account balances	2010-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	7
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	3
Total of all active and inactive participants	2009-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	10
Number of participants with account balances	2009-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN

Measure	Date	Value
2010 : NORTHSHORE MEDICAL ASSOCIATES 401(K) 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	$104,640
Expenses. Total of all expenses incurred	2010-12-31	$5,240
Benefits paid (including direct rollovers)	2010-12-31	$5,240
Total plan assets at end of year	2010-12-31	$409,761
Total plan assets at beginning of year	2010-12-31	$310,361
Value of fidelity bond covering the plan	2010-12-31	$25,000
Total contributions received or receivable from participants	2010-12-31	$29,019
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	$60,995
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$99,400
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$409,761
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$310,361
Assets. Value of participant loans	2010-12-31	$12,586
Total contributions received or receivable from employer(s)	2010-12-31	$14,626
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

Form 5500 Responses for NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN

2010: NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
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
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: NORTHSHORE MEDICAL ASSOCIATES 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
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
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

24790

Policy instance

Insurance contract or identification number	24790
Number of Individuals Covered	8
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,562
Total amount of fees paid to insurance company	USD $195
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 $1,562
Insurance broker organization code?	4
Amount paid for insurance broker fees	195
Additional information about fees paid to insurance broker	SALES/ADMINISTRATION
Insurance broker name	JULY BUSINESS SERVICES

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Company Name:	NORTHSHORE MEDICAL ASSOCIATES
Employer identification number (EIN):	760314950
NAIC Classification:	621399
NAIC Description:	Offices of All Other Miscellaneous Health Practitioners