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American Medical Technology 401k Profit Sharing Plan


Plan Information

  • Plan Year12/01/2007 — 11/30/2008
  • Date of Plan10/01/1996
  • Net Assets as of 11/30/2008 $165,226
  • Plan Number1
  • Plan Type Single Employer
  • Is the plan collectively bargained? No
  • Did the plan file for an extension of time or the DFVC Program? No
  • Plan Funding ArrangementInsurance
  • Plan Benefit ArrangementInsurance

Participant Information as of 11/30/2008

  • Active (Eligible) Participants46
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits4
  • Subtotal50
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total50
  • Total number of participants as of 12/01/200766
  • Number of participants with account balances21
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested18
  • Number of participants required to be reported on Schedule SSA2


  • Total Benefit Payments$0
  • Corrective Distributions$0
  • Administrative Service Providers$0
  • Other Expenses$0
  • Total Expenses$0
  • Total Transfers$0

Sponsor Information

  • Address8000 Katherine Blvd
  • CityBrecksville
  • StateOH
  • Zip44141-4202
  • Telephone(440) 717-4000
  • EIN34-1585439
  • Industry Code621610
  • Named AdministratorDonald J. Sladek
  • Named Plan SponsorG Picha

Plan Administrator Information

  • Administrator NameSAME
  • Administrator EIN

Benefits Provided Under the Plan

Code Benefit Description
2E Profit-sharing A defined contribution plan that allows employer discretionary contributions. These plans often contain a 401(k) feature.
2F ERISA section 404(c) Plan This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
2G 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.
2J 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.
2K 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 contributions 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.
3E Prototype plan A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a separate funding medium (for example, a separate trust or custodial account) is established for the use of each adopting employer.
3H Controlled Group Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

Questions and Answers

Question Answer Amount
During the plan year did the employer fail to transmit to the plan any participant contributions within the time period described in 29 CFT 2510.3-102? No
Were any loans by the plan or fixed income obligations due the plan in default as of the close of plan year or classified during the year as uncollectible? Disregard participant loans secured by participant's account balance. No
Were any leases to which the plan was a party in default or classified during the year as uncollectible? No
Were there any nonexempt transactions with any party-in-interest? No
Was this plan covered by a fidelity bond? Yes $100,000
Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud or dishonesty? No
Did the plan hold any assets whose current value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan receive any noncash contributions whose value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan at any time hold 20% or more of its assets in any single security, debt, mortgage, parcel of real estate, or partnership/joint venture interest? No $0
Are you claiming a waiver of the annual examination and report of an independent qualified public accountant (IQPA) under 29 CFR 2520.104-46? Yes
Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? No


Income and Expense Statement

Income $-21,326
Contributions $0
Cash Contributions $49,613
Cash from Employers $5,166
Cash from Participants $44,447
Others (including rollovers) $0
Noncash Contributions $0
Other Income $-70,939
Expenses $13,877
Total Benefit Payments $13,627
Corrective Distributions $0
Certain deemed distributions of participant loans $0
Other Expenses $250
Net Income $-35,203
Transfers of Assets to (from) this Plan $0

Asset and Liability Statement

11/30/2008 11/30/2007 Change YOY
Total Assets $165,226 $200,429 -17.56%
Total Liabilities $0 $0 0.0%
Net Assets $165,226 $200,429 -17.56%

Specific Assets Statement

Held? Amount
Total Specific Assets Yes $0
Partnership/joint venture interests Yes $0
Employer Real Property Yes $0
Real Estate Yes $0
Employer Securities Yes $0
Participant Loans Yes $0
Loans (other than to participants) Yes $0
Tangible Personal Property Yes $0

Service Providers

Service Providers

There are no service providers listed for this plan.



Name of Investment Investment Manager Type of Investment Dollar Value
Futurefunds Series Acct II of Gwl Great-West Life & Annuity Insurance DFE: Pooled Separate Account $116,289
Total $116,289

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Great West Retirement Services 21
EIN 84-0467907
Industry Code 68322
Contract Number 939778-01
Contract Year 12/01/2007 — 11/30/2008
Value in General Account at Year End $48,937
Value in Separate Accounts at Year End $116,289
Insurance Fees and Commissions $1,530
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Financial Telesis 3737 Park East Drive Ste 204 Beachwood, OH 44122 Insurance Agent or Broker $1,530 $0
Allocated Funds
Type of Contract Unspecified
Basis of premium rates
Premiums paid to carrier $0
Premiums due but unpaid at the end of the year $0
If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount $0
Specify the nature of the costs
Unallocated Funds
Type of Contract
Balance at the end of the previous year $14,382
Additions $35,047
Contributions Deposited during the year $1,599
Dividends and credits $0
Interest credited during the year $1,140
Transferred from separate account $32,308
Other $0
Total of Balance and Additions $49,429
Deductions $492
Disbursed from fund to pay benefits or purchase annuities during the year $492
Administration charge made by carrier $0
Transferred to Separate Account $0
Other $0
Balance at the end of the current year $48,937