WALDEMAR CHMIELEWSKI PROFIT SHARING PLAN

[ EIN: 95-4407621 | Plan No. 001 ]

Form 5500 filing classifies WALDEMAR CHMIELEWSKI PROFIT SHARING PLAN as a 401(k) plan, sponsored by WALDEMAR CHMIELEWSKI DDS. The plan is a Large Plan with 3 participants and total assets of $66,703 reported for the 2011 plan year.

401(k) plans are subject to ERISA disclosure requirements and annual reporting obligations.

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Plan Sponsor: WALDEMAR CHMIELEWSKI DDS

Location: 11510 S. VERMONT AVENUE, LOS ANGELES, CA 90044

EIN: 954407621

Plan Number: 001

Plan Year: 2011

Plan Size: Large Plan

Plan Entity Type: Defined Contribution

Plan Type: 401(k)

Participants: 3

Total Assets: $66,703

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