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DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN 401k Plan overview

Plan NameDON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN
Plan identification number 001

DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN Benefits

401k Plan TypeDefined 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.

401k Sponsoring company profile

DON E. SKAFF, D.D.S., INC. has sponsored the creation of one or more 401k plans.

Company Name:DON E. SKAFF, D.D.S., INC.
Employer identification number (EIN):920186835
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01DON E. SKAFF2015-02-11
0012013-01-01DON E. SKAFF2014-07-14
0012012-01-01DON E. SKAFF2013-07-12
0012011-01-01DON E. SKAFF
0012009-01-01DON E. SKAFF

Plan Statistics for DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN

401k plan membership statisitcs for DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN

Measure Date Value
2011: DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-019
Total number of active participants reported on line 7a of the Form 55002011-01-018
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-018
Number of participants with account balances2011-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-017
Total number of active participants reported on line 7a of the Form 55002009-01-016
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-011
Total of all active and inactive participants2009-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-017
Number of participants with account balances2009-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN

Measure Date Value
2011 : DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$77,791
Expenses. Total of all expenses incurred2011-12-31$30,926
Benefits paid (including direct rollovers)2011-12-31$30,926
Total plan assets at end of year2011-12-31$1,099,888
Total plan assets at beginning of year2011-12-31$1,053,023
Value of fidelity bond covering the plan2011-12-31$100,000
Total contributions received or receivable from participants2011-12-31$38,671
Contributions received from other sources (not participants or employers)2011-12-31$4,846
Other income received2011-12-31$-18,582
Net income (gross income less expenses)2011-12-31$46,865
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,099,888
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,053,023
Total contributions received or receivable from employer(s)2011-12-31$52,856
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources2010-12-31$213,178
Expenses. Total of all expenses incurred2010-12-31$7,143
Benefits paid (including direct rollovers)2010-12-31$7,143
Total plan assets at end of year2010-12-31$1,053,023
Total plan assets at beginning of year2010-12-31$846,988
Value of fidelity bond covering the plan2010-12-31$100,000
Total contributions received or receivable from participants2010-12-31$37,382
Other income received2010-12-31$123,940
Net income (gross income less expenses)2010-12-31$206,035
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,053,023
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$846,988
Total contributions received or receivable from employer(s)2010-12-31$51,856
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : DON E. SKAFF, D.D.S., 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 securities2009-12-31$0

Form 5500 Responses for DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN

2011: DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: DON E. SKAFF, D.D.S., INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number46178
Policy instance 1
Insurance contract or identification number46178
Number of Individuals Covered8
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $4,042
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number46178
Policy instance 1
Insurance contract or identification number46178
Number of Individuals Covered9
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,703
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $2,681
Insurance broker organization code?4
Insurance broker nameBENEFIT SOLUTIONS, INC.
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62944 )
Policy contract number920186835D1
Policy instance 2
Insurance contract or identification number920186835D1
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
JOHN HANCOCK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65099 )
Policy contract number920186835D1
Policy instance 3
Insurance contract or identification number920186835D1
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration1
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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

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