401k Plan data: CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN plan

CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN
Plan identification number	001

CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING 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
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 408 accounts and annuities - See Limited Pension Plan Reporting instructions for pension plan utilizing individual Code section 408 retirement accounts or annuities as the funding vehicle for providing benefits.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

CERTIFIED DENTAL STUDIO, INC. has sponsored the creation of one or more 401k plans.

Company Name: CERTIFIED DENTAL STUDIO, INC.

Employer identification number (EIN): 820508531

NAIC Classification: 621510
NAIC Description: Medical and Diagnostic Laboratories

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 GREG UNRUH 2017-02-02
001 2015-01-01 GREG UNRUH 2016-09-13
001 2014-01-01 GREG UNRUH
001 2013-01-01 CHARLES HOREL 2014-07-29
001 2012-01-01 CHARLES HOREL 2013-10-07
001 2011-01-01 GREG UNRUH 2012-10-15
001 2009-01-01 CHARLES HOREL

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2016-01-01	GREG UNRUH	2017-02-02
001	2015-01-01	GREG UNRUH	2016-09-13
001	2014-01-01	GREG UNRUH
001	2013-01-01	CHARLES HOREL	2014-07-29
001	2012-01-01	CHARLES HOREL	2013-10-07
001	2011-01-01	GREG UNRUH	2012-10-15
001	2009-01-01	CHARLES HOREL

Plan Statistics for CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN

Measure Date Value
2014: CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 4
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 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 4
Number of participants with account balances 2014-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2009: CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 4
Total of all active and inactive participants 2009-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 5

Measure	Date	Value
2014: CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	4
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	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	4
Number of participants with account balances	2014-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2009: CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	4
Total of all active and inactive participants	2009-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	5

Financial Data on CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN

Measure	Date	Value
2014 : CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$61,166
Expenses. Total of all expenses incurred	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$662,326
Total plan assets at beginning of year	2014-12-31	$601,160
Other income received	2014-12-31	$31,166
Net income (gross income less expenses)	2014-12-31	$61,166
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$662,326
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$601,160
Total contributions received or receivable from employer(s)	2014-12-31	$30,000
2010 : CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$69,087
Expenses. Total of all expenses incurred	2010-12-31	$10,516
Total plan assets at end of year	2010-12-31	$432,677
Total plan assets at beginning of year	2010-12-31	$374,106
Other income received	2010-12-31	$29,087
Net income (gross income less expenses)	2010-12-31	$58,571
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$432,677
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$374,106
Total contributions received or receivable from employer(s)	2010-12-31	$40,000
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$10,516
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING PLAN

2014: CERTIFIED DENTAL STUDIO, INC. PROFIT SHARING 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 – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2009: CERTIFIED DENTAL STUDIO, INC. 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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )

Policy contract number

70848677

Policy instance

Insurance contract or identification number	70848677
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 $10,496
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 $8,163
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	4
Insurance broker name	ASH BROKERAGE CORP

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Company Name:	CERTIFIED DENTAL STUDIO, INC.
Employer identification number (EIN):	820508531
NAIC Classification:	621510
NAIC Description:	Medical and Diagnostic Laboratories