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FORM 5500 DATA

ANGMAR Medical Holdings, Inc 401k Plan

Overview

Plan Information

  • Plan Year01/01/2012 — 12/31/2012
  • Date of Plan01/01/2002
  • Net Assets as of 12/31/2012 $729,081
  • 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?Yes
  • Plan Funding ArrangementInsurance Trust
  • Plan Benefit ArrangementInsurance Trust

Participant Information as of 12/31/2012

  • Active (Eligible) Participants478
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits23
  • Subtotal501
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total501
  • Total number of participants as of 01/01/2012363
  • Number of participants with account balances60
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2

Expenses

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

Sponsor Information

  • Address2301 Highway 1187 Suite 203
  • CityMansfield
  • StateTX
  • Zip76063
  • Telephone(817) 469-6739
  • EIN75-2863389
  • Industry Code621610
  • Named AdministratorThuy Kieu

Plan Administrator Information

  • Administrator NameAngmar Medical Holdings, Inc.
  • Address2301 Highway 1187 Suite 203
  • CityMansfield
  • StateTX
  • Zip76063
  • Telephone(817) 469-6739
  • Administrator EIN75-2863389

Audit Information

  • Audit StatusAudited
  • AuditorBrimer, Perry and Associates
  • Auditor EIN20-0624227
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

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.
2T Participant-directed Account Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
3D 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.
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? Yes $486
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 $500,000
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 have assets held for investment? Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? No
Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? No
Has the plan failed to provide any benefit when due under the plan? No
If this is an individual account plan, was there a blackout period? Yes
If there was a blackout period, have you either provided the required notice or one of the exceptions to providing the notice applied under 29 CFR 2520.101-3? Yes

Financials

Income and Expense Statement

Income $216,171
Contributions $164,030
Cash Contributions $164,030
Cash from Employers $19,805
Cash from Participants $144,225
Others (including rollovers) $0
Noncash Contributions $0
Total Earnings on Investments $52,172
Total Interest $1,992
Interest-Bearing Cash $113
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $1,879
Interest from Other Investments $0
Total Dividends $12,888
Preferred Stock $0
Common Stock $0
Rents $0
Net gain (loss) on sale of assets $0
Aggregate Proceeds $0
Aggregate Carrying Amount $0
Total Unrealized Appreciation (depreciation) of assets $0
Real Estate $0
Other $0
Net investment gain (loss) from common/collective trusts $0
Net investment gain (loss) from pooled separate accounts $45,930
Net investment gain (loss) from master trust investment accounts $0
Net investment gain (loss) from 103-12 investment entities $0
Net investment gain (loss) from registered investment companies $-8,638
Other Income $-31
Expenses $211,112
Total Benefit Payments $201,744
Directly to participants or beneficiaries, including direct rollovers $201,744
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $0
Certain deemed distributions of participant loans $4,502
Interest expense $0
Total Administrative Expenses $4,866
Professional Fees $0
Contract Administrator Fees $0
Investment Advisory and management fees $0
Other Administrative Fees $4,866
Net Income $5,059
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2012 12/31/2011 Change YOY
Total Assets $729,081 $724,022 0.70%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $1,419 $5,530 -74.34%
Employer Contributions $0 $751 -100.00%
Participant Contributions $1,419 $4,779 -70.31%
Other Contributions $0 $0 0.0%
General Investments $4,921 $0 0.0%
Interest-bearing cash $4,921 $0 0.0%
U.S. Government Securities $0 $0 0.0%
Corporate Debt Instruments $0 $0 0.0%
Preferred $0 $0 0.0%
All Other $0 $0 0.0%
Corporate Stocks $0 $0 0.0%
Preferred $0 $0 0.0%
Common $0 $0 0.0%
Partnership/joint venture interests $0 $0 0.0%
Real estate (other than employer real property) $0 $0 0.0%
Loans (other than to participants) $0 $0 0.0%
Participants Loans $27,220 $48,702 -44.11%
Value of interest in common/collective trusts $0 $0 0.0%
Value of interest in pooled separate accounts $0 $669,790 -100.00%
Value of interest in master trust investment accounts $0 $0 0.0%
Value of interest in 103-12 investment entities $0 $0 0.0%
Value of interest in registered investment companies $695,521 $0 0.0%
Value of funds held in insurance co. general account $0 $0 0.0%
Other Investments $0 $0 0.0%
Employer-related Investments $0 $0 0.0%
Employer Securities $0 $0 0.0%
Employer Real Property $0 $0 0.0%
Buildings and other property used in plan operation $0 $0 0.0%
Total Liabilities $0 $0 0.0%
Benefit Claims Payable (1) $0 $0 0.0%
Operating Payables (1) $0 $0 0.0%
Acquisition Indebtedness (1) $0 $0 0.0%
Other liabilities (1) $0 $0 0.0%
Net Assets $729,081 $724,022 0.70%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

  • Fid.Inv.Inst.Ops.Co.

Other Service Providers Receiving Direct or Indirect Compensation

Name Nature of Service Relationship to Plan Sponsor Direct Compensation Paid by Plan Indirect Compensation Paid by Plan Total Compensation
Fidelity Investments Institutional Recordkeeping fees, Participant loan processing, Account maintenance fees, Sub-transfer agency fees Recordkeeper $1,637 $0 $1,637
Total $1,637 $0 $1,637

Indirect Compensation

Name Source of Indirect Compensation* Nature of Service Description of Indirect Compensation Indirect Compensation Paid by Plan
Fidelity Investments Institutional Cohen & Steers Rlty - Boston Financ Sub-transfer agency fees 0.40% $0
Fidelity Investments Institutional Harbor Intl Inv - Principal Shareho Sub-transfer agency fees 0.40% $0
Fidelity Investments Institutional Invs Divrs Divd R5 - Invesco Aim In Sub-transfer agency fees 0.35% $0
Fidelity Investments Institutional Metwest Tot Rtn Bd M - Bank of New Sub-transfer agency fees 0.35% $0
Fidelity Investments Institutional Pimco Real Rtn Bd Ad - Boston Finan Sub-transfer agency fees 0.27% $0
Fidelity Investments Institutional Trp Div Growth Adv - T. Rowe Price Sub-transfer agency fees 0.40% $0
Fidelity Investments Institutional Wfa Prec Metals A - Boston Financia Sub-transfer agency fees 0.55% $0
*As outlined by the Form 5500 Instructions for service providers with indirect compensation.

Service Providers Who Fail or Refuse to Provide Information

There are no service providers who failed or refused to provide information.

Termination Information on Accountants and Enrolled Actuaries

There is no termination information for this plan.

Investments

Investments

Name of Investment Investment Manager Type of Investment Dollar Value
Hartford Advantage Tk4 Hartford Life Insurance Co. DFE: Pooled Separate Account $0
Separate Account K4 Hartford Life Insurance Co. DFE: Pooled Separate Account $0
Total $0

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Hartford Life Insurance Company 0
EIN 06-0974148
Industry Code 88072
Contract Number GA-807227
Contract Year 01/01/2012 — 08/31/2012
Value in General Account at Year End $0
Value in Separate Accounts at Year End $0
Insurance Fees and Commissions $2,146
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
LPL Financial LLC 9785 Towne Centre Dr San Diego, CA 92121 -1968 Insurance Agent or Broker $1,844 $42 SALES/MARKETING
Pentec Pension Management Group Inc 310 W Wall St Ste 600 Midland, TX 79701 -5123 $0 $260
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 Unspecified
Balance at the end of the previous year $0
Additions $0
Contributions Deposited during the year $0
Dividends and credits $0
Interest credited during the year $0
Transferred from separate account $0
Other $0
Total of Balance and Additions $0
Deductions $0
Disbursed from fund to pay benefits or purchase annuities during the year $0
Administration charge made by carrier $0
Transferred to Separate Account $0
Other $0
Balance at the end of the current year $0