401k Plan data: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN plan

NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN
Plan identification number	001

NAKAMURA & MITOMA, D.D.S., 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

401k Sponsoring company profile

NAKAMURA & MITOMA, D.D.S., INC. has sponsored the creation of one or more 401k plans.

Company Name: NAKAMURA & MITOMA, D.D.S., INC.

Employer identification number (EIN): 943367009

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 EDWARD MITOMA 2023-10-11 EDWARD MITOMA 2023-10-11
001 2021-01-01 EDWARD MITOMA 2022-09-29 EDWARD MITOMA 2022-09-29
001 2020-01-01 EDWARD MITOMA 2021-09-07 EDWARD MITOMA 2021-09-07
001 2019-01-01 EDWARD MITOMA 2020-09-20 EDWARD MITOMA 2020-09-20
001 2018-01-01 EDWARD MITOMA 2019-08-01 EDWARD MITOMA 2019-08-01
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01
001 2013-01-01
001 2012-01-01 EDWARD MITOMA EDWARD MITOMA 2013-10-14
001 2011-01-01 EDWARD MITOMA EDWARD MITOMA 2012-10-15
001 2010-01-01 LVEZINA LVEZINA 2011-09-15
001 2009-01-01 JBEASLEY JBEASLEY 2010-10-12
001 2009-01-01 JBEASLEY JBEASLEY 2010-10-13
001 2009-01-01 LVEZINA LVEZINA 2011-09-15
001 2009-01-01 JBEASLEY JBEASLEY 2010-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	EDWARD MITOMA	2023-10-11	EDWARD MITOMA	2023-10-11
001	2021-01-01	EDWARD MITOMA	2022-09-29	EDWARD MITOMA	2022-09-29
001	2020-01-01	EDWARD MITOMA	2021-09-07	EDWARD MITOMA	2021-09-07
001	2019-01-01	EDWARD MITOMA	2020-09-20	EDWARD MITOMA	2020-09-20
001	2018-01-01	EDWARD MITOMA	2019-08-01	EDWARD MITOMA	2019-08-01
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01
001	2013-01-01
001	2012-01-01	EDWARD MITOMA		EDWARD MITOMA	2013-10-14
001	2011-01-01	EDWARD MITOMA		EDWARD MITOMA	2012-10-15
001	2010-01-01	LVEZINA		LVEZINA	2011-09-15
001	2009-01-01	JBEASLEY		JBEASLEY	2010-10-12
001	2009-01-01	JBEASLEY		JBEASLEY	2010-10-13
001	2009-01-01	LVEZINA		LVEZINA	2011-09-15
001	2009-01-01	JBEASLEY		JBEASLEY	2010-10-13

Plan Statistics for NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN

401k plan membership statisitcs for NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN

Measure Date Value
2022: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 9
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 1
Total of all active and inactive participants 2022-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 10
Number of participants with account balances 2022-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 13
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 1
Total of all active and inactive participants 2021-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 14
Number of participants with account balances 2021-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 11
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 1
Total of all active and inactive participants 2020-01-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 12
Number of participants with account balances 2020-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 13
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 1
Total of all active and inactive participants 2019-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 14
Number of participants with account balances 2019-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 11
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 2
Total of all active and inactive participants 2018-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 13
Number of participants with account balances 2018-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 9
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 2
Total of all active and inactive participants 2017-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 11
Number of participants with account balances 2017-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 9
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 4
Total of all active and inactive participants 2016-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 13
Number of participants with account balances 2016-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 7
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 4
Total of all active and inactive participants 2015-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 11
Number of participants with account balances 2015-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 7
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 4
Total of all active and inactive participants 2014-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 11
Number of participants with account balances 2014-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 8
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 3
Total of all active and inactive participants 2013-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 11
Number of participants with account balances 2013-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 8
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 3
Total of all active and inactive participants 2012-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 11
Number of participants with account balances 2012-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 6
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 1
Total of all active and inactive participants 2011-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 7
Number of participants with account balances 2011-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING 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: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 8
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 2
Total of all active and inactive participants 2009-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 8
Number of participants with account balances 2009-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2022: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	9
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	1
Total of all active and inactive participants	2022-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	10
Number of participants with account balances	2022-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	13
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	1
Total of all active and inactive participants	2021-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	14
Number of participants with account balances	2021-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	11
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	1
Total of all active and inactive participants	2020-01-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	12
Number of participants with account balances	2020-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	13
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	1
Total of all active and inactive participants	2019-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	14
Number of participants with account balances	2019-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	11
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	2
Total of all active and inactive participants	2018-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	13
Number of participants with account balances	2018-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	9
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	2
Total of all active and inactive participants	2017-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	11
Number of participants with account balances	2017-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	9
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	4
Total of all active and inactive participants	2016-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	13
Number of participants with account balances	2016-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	7
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	4
Total of all active and inactive participants	2015-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	11
Number of participants with account balances	2015-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	7
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	4
Total of all active and inactive participants	2014-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	11
Number of participants with account balances	2014-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	8
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	3
Total of all active and inactive participants	2013-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	11
Number of participants with account balances	2013-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	8
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	3
Total of all active and inactive participants	2012-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	11
Number of participants with account balances	2012-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	6
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	1
Total of all active and inactive participants	2011-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	7
Number of participants with account balances	2011-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING 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: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	8
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	2
Total of all active and inactive participants	2009-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	8
Number of participants with account balances	2009-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN

Measure	Date	Value
2022 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2022 401k financial data
Total income from all sources	2022-12-31	$-54,077
Expenses. Total of all expenses incurred	2022-12-31	$0
Total plan assets at end of year	2022-12-31	$448,020
Total plan assets at beginning of year	2022-12-31	$502,097
Total contributions received or receivable from participants	2022-12-31	$0
Expenses. Other expenses not covered elsewhere	2022-12-31	$0
Contributions received from other sources (not participants or employers)	2022-12-31	$0
Other income received	2022-12-31	$-96,624
Net income (gross income less expenses)	2022-12-31	$-54,077
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$448,020
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$502,097
Total contributions received or receivable from employer(s)	2022-12-31	$42,547
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$0
2021 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources	2021-12-31	$34,837
Expenses. Total of all expenses incurred	2021-12-31	$0
Total plan assets at end of year	2021-12-31	$502,097
Total plan assets at beginning of year	2021-12-31	$467,260
Total contributions received or receivable from participants	2021-12-31	$0
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$34,837
Net income (gross income less expenses)	2021-12-31	$34,837
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$502,097
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$467,260
Total contributions received or receivable from employer(s)	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$0
2020 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources	2020-12-31	$79,857
Expenses. Total of all expenses incurred	2020-12-31	$0
Total plan assets at end of year	2020-12-31	$467,260
Total plan assets at beginning of year	2020-12-31	$387,403
Total contributions received or receivable from participants	2020-12-31	$0
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$79,857
Net income (gross income less expenses)	2020-12-31	$79,857
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$467,260
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$387,403
Total contributions received or receivable from employer(s)	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$0
2019 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$45,196
Expenses. Total of all expenses incurred	2019-12-31	$1,476
Benefits paid (including direct rollovers)	2019-12-31	$1,476
Total plan assets at end of year	2019-12-31	$387,403
Total plan assets at beginning of year	2019-12-31	$343,683
Total contributions received or receivable from participants	2019-12-31	$0
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$45,196
Net income (gross income less expenses)	2019-12-31	$43,720
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$387,403
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$343,683
Total contributions received or receivable from employer(s)	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$0
2018 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$21,794
Expenses. Total of all expenses incurred	2018-12-31	$0
Total plan assets at end of year	2018-12-31	$343,683
Total plan assets at beginning of year	2018-12-31	$321,889
Value of fidelity bond covering the plan	2018-12-31	$32,000
Total contributions received or receivable from participants	2018-12-31	$0
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$21,794
Net income (gross income less expenses)	2018-12-31	$21,794
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$343,683
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$321,889
Total contributions received or receivable from employer(s)	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$0
2017 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$4,283
Expenses. Total of all expenses incurred	2017-12-31	$8,379
Benefits paid (including direct rollovers)	2017-12-31	$8,379
Total plan assets at end of year	2017-12-31	$321,889
Total plan assets at beginning of year	2017-12-31	$325,985
Value of fidelity bond covering the plan	2017-12-31	$32,000
Total contributions received or receivable from participants	2017-12-31	$0
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$4,283
Net income (gross income less expenses)	2017-12-31	$-4,096
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$321,889
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$325,985
Total contributions received or receivable from employer(s)	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$0
2016 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$7,123
Expenses. Total of all expenses incurred	2016-12-31	$0
Total plan assets at end of year	2016-12-31	$325,985
Total plan assets at beginning of year	2016-12-31	$318,862
Value of fidelity bond covering the plan	2016-12-31	$32,000
Total contributions received or receivable from participants	2016-12-31	$0
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$7,123
Net income (gross income less expenses)	2016-12-31	$7,123
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$325,985
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$318,862
Total contributions received or receivable from employer(s)	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$0
2015 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$6,904
Expenses. Total of all expenses incurred	2015-12-31	$75,000
Total plan assets at end of year	2015-12-31	$318,862
Total plan assets at beginning of year	2015-12-31	$386,958
Value of fidelity bond covering the plan	2015-12-31	$132,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$6,904
Net income (gross income less expenses)	2015-12-31	$-68,096
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$318,862
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$386,958
Total contributions received or receivable from employer(s)	2015-12-31	$0
Value of certain deemed distributions of participant loans	2015-12-31	$75,000
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$0
2014 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$70,228
Expenses. Total of all expenses incurred	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$386,958
Total plan assets at beginning of year	2014-12-31	$316,730
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$70,228
Net income (gross income less expenses)	2014-12-31	$70,228
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$386,958
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$316,730
Assets. Value of participant loans	2014-12-31	$75,000
Total contributions received or receivable from employer(s)	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$0
2013 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$-64,603
Expenses. Total of all expenses incurred	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$316,730
Total plan assets at beginning of year	2013-12-31	$381,333
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$-94,603
Net income (gross income less expenses)	2013-12-31	$-64,603
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$316,730
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$381,333
Assets. Value of participant loans	2013-12-31	$75,000
Total contributions received or receivable from employer(s)	2013-12-31	$30,000
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
2012 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$91,636
Expenses. Total of all expenses incurred	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$381,333
Total plan assets at beginning of year	2012-12-31	$289,697
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$61,636
Net income (gross income less expenses)	2012-12-31	$91,636
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$381,333
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$289,697
Assets. Value of participant loans	2012-12-31	$75,000
Total contributions received or receivable from employer(s)	2012-12-31	$30,000
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
2011 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$-121,319
Expenses. Total of all expenses incurred	2011-12-31	$-4,735
Benefits paid (including direct rollovers)	2011-12-31	$-4,735
Total plan assets at end of year	2011-12-31	$204,052
Total plan assets at beginning of year	2011-12-31	$320,636
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-151,319
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-116,584
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$204,052
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$320,636
Assets. Value of participant loans	2011-12-31	$75,000
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$30,000
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
2010 : NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING 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	$22,330
Expenses. Total of all expenses incurred	2010-12-31	$4,735
Benefits paid (including direct rollovers)	2010-12-31	$4,735
Total plan assets at end of year	2010-12-31	$320,636
Total plan assets at beginning of year	2010-12-31	$303,041
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$0
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	$-23,804
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$17,595
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$320,636
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$303,041
Assets. Value of participant loans	2010-12-31	$75,000
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$30,000
Total contributions received or receivable from employer(s)	2010-12-31	$46,134
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

Form 5500 Responses for NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN

2022: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: NAKAMURA & MITOMA, D.D.S., 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
2013: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: NAKAMURA & MITOMA, D.D.S., INC. PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
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: NAKAMURA & MITOMA, D.D.S., 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 – 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

THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 )

Policy contract number

INDIV CONTRACTS

Policy instance

Insurance contract or identification number	INDIV CONTRACTS
Number of Individuals Covered	4
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0

THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 )

Policy contract number

INDIV CONTRACTS

Policy instance

Insurance contract or identification number	INDIV CONTRACTS
Number of Individuals Covered	4
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0

THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 )

Policy contract number

INDIV CONTRACTS

Policy instance

Insurance contract or identification number	INDIV CONTRACTS
Number of Individuals Covered	4
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0

THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 )

Policy contract number

INDIV CONTRACTS

Policy instance

Insurance contract or identification number	INDIV CONTRACTS
Number of Individuals Covered	4
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0

THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 )

Policy contract number

INDIV CONTRACTS

Policy instance

Insurance contract or identification number	INDIV CONTRACTS
Number of Individuals Covered	4
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0

THE LAFAYETTE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65242 )

Policy contract number

INDIV CONTRACTS

Policy instance

Insurance contract or identification number	INDIV CONTRACTS
Number of Individuals Covered	6
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0

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Company Name:	NAKAMURA & MITOMA, D.D.S., INC.
Employer identification number (EIN):	943367009
NAIC Classification:	621210
NAIC Description:	Offices of Dentists