401k Plan data: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST plan

JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 401k Plan overview

Plan Name	JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST
Plan identification number	003

JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST Benefits

401k Plan Type	Defined Benefit Pension
Plan Features/Benefits	Benefits are primarily flat dollar (includes dollars per year of service) Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).

401k Sponsoring company profile

JOHN T. GREEN, D.D.S., INC. has sponsored the creation of one or more 401k plans.

Company Name: JOHN T. GREEN, D.D.S., INC.

Employer identification number (EIN): 310884898

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2017-01-01
003 2016-01-01
003 2015-01-01 JOHN T. GREEN, D.D.S. 2016-09-09
003 2014-01-01 JOHN T. GREEN, D.D.S. 2015-06-16
003 2013-01-01 JOHN T. GREEN, D.D.S. 2014-08-08
003 2012-01-01 JOHN T. GREEN, D.D.S. 2013-09-27
003 2011-01-01 JOHN T. GREEN, D.D.S.
003 2010-01-01 JOHN T. GREEN, D.D.S.
003 2009-01-01 JOHN T. GREEN, D.D.S.
003 2009-01-01 JOHN T. GREEN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
003	2017-01-01
003	2016-01-01
003	2015-01-01	JOHN T. GREEN, D.D.S.	2016-09-09
003	2014-01-01	JOHN T. GREEN, D.D.S.	2015-06-16
003	2013-01-01	JOHN T. GREEN, D.D.S.	2014-08-08
003	2012-01-01	JOHN T. GREEN, D.D.S.	2013-09-27
003	2011-01-01	JOHN T. GREEN, D.D.S.
003	2010-01-01	JOHN T. GREEN, D.D.S.
003	2009-01-01	JOHN T. GREEN, D.D.S.
003	2009-01-01	JOHN T. GREEN

Plan Statistics for JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST

401k plan membership statisitcs for JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST

Measure Date Value
2016: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 2016 401k membership
Market value of plan assets 2016-12-31 827,488
Acturial value of plan assets 2016-12-31 827,488
Funding target for retired participants and beneficiaries receiving payment 2016-12-31 0
Number of terminated vested participants 2016-12-31 2
Fundng target for terminated vested participants 2016-12-31 0
Active participant vested funding target 2016-12-31 776,017
Number of active participants 2016-12-31 10
Total funding liabilities for active participants 2016-12-31 776,017
Total participant count 2016-12-31 12
Total funding target for all participants 2016-12-31 776,017
Balance at beginning of prior year after applicable adjustments 2016-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2016-12-31 160,643
Carryover balanced portion elected for use to offset prior years funding requirement 2016-12-31 0
Prefunding balanced used to offset prior years funding requirement 2016-12-31 43,286
Amount remaining of carryover balance 2016-12-31 0
Amount remaining of prefunding balance 2016-12-31 117,357
Present value of excess contributions 2016-12-31 1,300
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2016-12-31 1,300
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2016-12-31 0
Reductions in caryover balances due to elections or deemed elections 2016-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2016-12-31 0
Balance of carryovers at beginning of current year 2016-12-31 0
Balance of prefunding at beginning of current year 2016-12-31 118,038
Total employer contributions 2016-12-31 230,000
Total employee contributions 2016-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2016-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2016-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2016-12-31 225,218
Unpaid minimum required contributions for all prior years 2016-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2016-12-31 0
Remaining amount of unpaid minimum required contributions 2016-12-31 0
Minimum required contributions for current year target normal cost 2016-12-31 105,671
Net shortfall amortization installment of oustanding balance 2016-12-31 12,398
Total funding amount beforereflecting carryover/prefunding balances 2016-12-31 107,991
Additional cash requirement 2016-12-31 107,991
Contributions allocatedtoward minimum required contributions for current year 2016-12-31 225,218
Unpaid minimum required contributions for current year 2016-12-31 0
Unpaid minimum required contributions for all years 2016-12-31 0
2011: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 11
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 0
Total of all active and inactive participants 2011-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 10
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 1
Total of all active and inactive participants 2010-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 10
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 0
Total of all active and inactive participants 2009-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2016: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 2016 401k membership
Market value of plan assets	2016-12-31	827,488
Acturial value of plan assets	2016-12-31	827,488
Funding target for retired participants and beneficiaries receiving payment	2016-12-31	0
Number of terminated vested participants	2016-12-31	2
Fundng target for terminated vested participants	2016-12-31	0
Active participant vested funding target	2016-12-31	776,017
Number of active participants	2016-12-31	10
Total funding liabilities for active participants	2016-12-31	776,017
Total participant count	2016-12-31	12
Total funding target for all participants	2016-12-31	776,017
Balance at beginning of prior year after applicable adjustments	2016-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2016-12-31	160,643
Carryover balanced portion elected for use to offset prior years funding requirement	2016-12-31	0
Prefunding balanced used to offset prior years funding requirement	2016-12-31	43,286
Amount remaining of carryover balance	2016-12-31	0
Amount remaining of prefunding balance	2016-12-31	117,357
Present value of excess contributions	2016-12-31	1,300
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2016-12-31	1,300
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2016-12-31	0
Reductions in caryover balances due to elections or deemed elections	2016-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2016-12-31	0
Balance of carryovers at beginning of current year	2016-12-31	0
Balance of prefunding at beginning of current year	2016-12-31	118,038
Total employer contributions	2016-12-31	230,000
Total employee contributions	2016-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2016-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2016-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2016-12-31	225,218
Unpaid minimum required contributions for all prior years	2016-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2016-12-31	0
Remaining amount of unpaid minimum required contributions	2016-12-31	0
Minimum required contributions for current year target normal cost	2016-12-31	105,671
Net shortfall amortization installment of oustanding balance	2016-12-31	12,398
Total funding amount beforereflecting carryover/prefunding balances	2016-12-31	107,991
Additional cash requirement	2016-12-31	107,991
Contributions allocatedtoward minimum required contributions for current year	2016-12-31	225,218
Unpaid minimum required contributions for current year	2016-12-31	0
Unpaid minimum required contributions for all years	2016-12-31	0
2011: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	11
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	0
Total of all active and inactive participants	2011-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	10
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	1
Total of all active and inactive participants	2010-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	10
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	0
Total of all active and inactive participants	2009-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST

Measure	Date	Value
2011 : JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 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	$164,542
Expenses. Total of all expenses incurred	2011-12-31	$18,241
Benefits paid (including direct rollovers)	2011-12-31	$10,225
Total plan assets at end of year	2011-12-31	$1,020,567
Total plan assets at beginning of year	2011-12-31	$874,265
Value of fidelity bond covering the plan	2011-12-31	$500,000
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	$33,220
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$146,301
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,020,567
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$874,265
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$27,863
Total contributions received or receivable from employer(s)	2011-12-31	$131,322
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	$8,016
2010 : JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 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	$203,352
Expenses. Total of all expenses incurred	2010-12-31	$5,406
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$874,265
Total plan assets at beginning of year	2010-12-31	$676,319
Value of fidelity bond covering the plan	2010-12-31	$500,000
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	$73,352
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$197,946
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$874,265
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$676,319
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$37,151
Total contributions received or receivable from employer(s)	2010-12-31	$130,000
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	$5,406

Form 5500 Responses for JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST

2011: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 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 – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: JOHN T. GREEN, D.D.S. INC. DEFINED BENEFIT PENSION PLAN & TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	JOHN T. GREEN, D.D.S., INC.
Employer identification number (EIN):	310884898
NAIC Classification:	621210
NAIC Description:	Offices of Dentists