401k Plan data: ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN plan

ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN 401k Plan overview

Plan Name	ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN
Plan identification number	001

ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Money purchase (other than target benefit)
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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

ROGER P. FIELDMAN DDS INC. has sponsored the creation of one or more 401k plans.

Company Name: ROGER P. FIELDMAN DDS INC.

Employer identification number (EIN): 953126532

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-03-23 ROGER FIELDMAN 2013-09-19 ROGER FIELDMAN 2013-09-19
001 2012-01-01 MATTHEW WALKER
001 2011-01-01 MATTHEW WALKER
001 2009-01-01 ROLLY THROCKMORTON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2012-03-23	ROGER FIELDMAN	2013-09-19	ROGER FIELDMAN	2013-09-19
001	2012-01-01	MATTHEW WALKER
001	2011-01-01	MATTHEW WALKER
001	2009-01-01	ROLLY THROCKMORTON

Financial Data on ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN

Measure	Date	Value
2012 : ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN 2012 401k financial data
Total plan liabilities at end of year	2012-11-06	$0
Total plan liabilities at beginning of year	2012-11-06	$1,690
Total income from all sources	2012-11-06	$209,147
Expenses. Total of all expenses incurred	2012-11-06	$3,804,496
Benefits paid (including direct rollovers)	2012-11-06	$3,804,496
Total plan assets at end of year	2012-11-06	$0
Total plan assets at beginning of year	2012-11-06	$3,597,039
Value of fidelity bond covering the plan	2012-11-06	$1,500,000
Other income received	2012-11-06	$146,564
Net income (gross income less expenses)	2012-11-06	$-3,595,349
Net plan assets at end of year (total assets less liabilities)	2012-11-06	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-11-06	$3,595,349
Total contributions received or receivable from employer(s)	2012-11-06	$62,583
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-11-06	$0
Funding deficiency by the employer to the plan for this plan year	2012-11-06	$0
Minimum employer required contribution for this plan year	2012-11-06	$62,583
Amount contributed by the employer to the plan for this plan year	2012-11-06	$62,583
2011 : ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN 2011 401k financial data
Total plan liabilities at end of year	2011-12-31	$1,690
Total plan liabilities at beginning of year	2011-12-31	$7
Total income from all sources	2011-12-31	$261,950
Expenses. Total of all expenses incurred	2011-12-31	$168,484
Benefits paid (including direct rollovers)	2011-12-31	$168,484
Total plan assets at end of year	2011-12-31	$3,597,039
Total plan assets at beginning of year	2011-12-31	$3,501,890
Value of fidelity bond covering the plan	2011-12-31	$1,500,000
Other income received	2011-12-31	$46,370
Net income (gross income less expenses)	2011-12-31	$93,466
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$3,595,349
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$3,501,883
Total contributions received or receivable from employer(s)	2011-12-31	$215,580
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$215,580
Amount contributed by the employer to the plan for this plan year	2011-12-31	$215,580
2010 : ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$7
Total plan liabilities at beginning of year	2010-12-31	$49,947
Total income from all sources	2010-12-31	$414,916
Expenses. Total of all expenses incurred	2010-12-31	$973,944
Benefits paid (including direct rollovers)	2010-12-31	$973,944
Total plan assets at end of year	2010-12-31	$3,501,890
Total plan assets at beginning of year	2010-12-31	$4,110,858
Value of fidelity bond covering the plan	2010-12-31	$1,500,000
Other income received	2010-12-31	$204,448
Net income (gross income less expenses)	2010-12-31	$-559,028
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$3,501,883
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$4,060,911
Total contributions received or receivable from employer(s)	2010-12-31	$210,468
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$210,468
Amount contributed by the employer to the plan for this plan year	2010-12-31	$210,468
2009 : ROGER P. FIELDMAN DDS INC. RETIREMENT 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
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$217,533
Amount contributed by the employer to the plan for this plan year	2009-12-31	$217,533

Form 5500 Responses for ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN

2012: ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	This submission is the final filing	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	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: ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: ROGER P. FIELDMAN DDS INC. RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
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

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	005513
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	005513
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	005513
Policy instance	1

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Company Name:	ROGER P. FIELDMAN DDS INC.
Employer identification number (EIN):	953126532
NAIC Classification:	621210
NAIC Description:	Offices of Dentists