401k Plan data: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN plan

KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 401k Plan overview

Plan Name	KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN
Plan identification number	001

KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
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

KEITH A. JOHNSON, D.D.S., P.C. has sponsored the creation of one or more 401k plans.

Company Name: KEITH A. JOHNSON, D.D.S., P.C.

Employer identification number (EIN): 421193011

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01
001 2015-01-01
001 2014-01-01
001 2013-01-01
001 2012-01-01 KEITH A JOHNSON DDS KEITH A JOHNSON DDS 2013-10-14
001 2011-01-01 KEITH A JOHNSON DDS 2012-03-12 KEITH A JOHNSON DDS 2012-03-12
001 2010-01-01 KEITH A JOHNSON DDS 2011-07-15 KEITH A JOHNSON DDS 2011-07-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01
001	2015-01-01
001	2014-01-01
001	2013-01-01
001	2012-01-01	KEITH A JOHNSON DDS		KEITH A JOHNSON DDS	2013-10-14
001	2011-01-01	KEITH A JOHNSON DDS	2012-03-12	KEITH A JOHNSON DDS	2012-03-12
001	2010-01-01	KEITH A JOHNSON DDS	2011-07-15	KEITH A JOHNSON DDS	2011-07-15

Plan Statistics for KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN

401k plan membership statisitcs for KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN

Measure Date Value
2016: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 7
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 7
Number of participants with account balances 2015-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 7
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 8
Number of participants with account balances 2014-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 8
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 10
Number of participants with account balances 2013-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2012: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 8
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 1
Total of all active and inactive participants 2012-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 9
Number of participants with account balances 2012-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2016: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	7
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	7
Number of participants with account balances	2015-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	7
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	8
Number of participants with account balances	2014-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	8
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	10
Number of participants with account balances	2013-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2012: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	8
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	1
Total of all active and inactive participants	2012-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	9
Number of participants with account balances	2012-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN

Measure	Date	Value
2016 : KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$93,921
Expenses. Total of all expenses incurred	2016-12-31	$993,014
Benefits paid (including direct rollovers)	2016-12-31	$988,754
Total plan assets at end of year	2016-12-31	$0
Total plan assets at beginning of year	2016-12-31	$899,093
Value of fidelity bond covering the plan	2016-12-31	$250,000
Total contributions received or receivable from participants	2016-12-31	$0
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$69,528
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$-899,093
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$899,093
Assets. Value of real-estate (other than employer real property)	2016-12-31	$0
Total contributions received or receivable from employer(s)	2016-12-31	$24,393
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$4,260
2015 : KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$42,957
Expenses. Total of all expenses incurred	2015-12-31	$17,523
Benefits paid (including direct rollovers)	2015-12-31	$6,210
Total plan assets at end of year	2015-12-31	$899,093
Total plan assets at beginning of year	2015-12-31	$873,659
Value of fidelity bond covering the plan	2015-12-31	$250,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$10,626
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-16,080
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$25,434
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$899,093
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$873,659
Assets. Value of real-estate (other than employer real property)	2015-12-31	$255,000
Total contributions received or receivable from employer(s)	2015-12-31	$59,037
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$687
2014 : KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$85,288
Expenses. Total of all expenses incurred	2014-12-31	$13,484
Benefits paid (including direct rollovers)	2014-12-31	$906
Total plan assets at end of year	2014-12-31	$873,659
Total plan assets at beginning of year	2014-12-31	$801,855
Value of fidelity bond covering the plan	2014-12-31	$250,000
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$11,015
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$23,075
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$71,804
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$873,659
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$801,855
Assets. Value of real-estate (other than employer real property)	2014-12-31	$235,000
Total contributions received or receivable from employer(s)	2014-12-31	$62,213
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$1,563
2013 : KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$124,017
Expenses. Total of all expenses incurred	2013-12-31	$12,878
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$801,855
Total plan assets at beginning of year	2013-12-31	$690,716
Value of fidelity bond covering the plan	2013-12-31	$220,000
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$12,832
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$59,926
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$111,139
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$801,855
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$690,716
Assets. Value of real-estate (other than employer real property)	2013-12-31	$220,000
Total contributions received or receivable from employer(s)	2013-12-31	$64,091
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$46
2012 : KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$97,817
Expenses. Total of all expenses incurred	2012-12-31	$137
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$690,716
Total plan assets at beginning of year	2012-12-31	$593,036
Value of fidelity bond covering the plan	2012-12-31	$155,000
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$35,640
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$97,680
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$690,716
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$593,036
Assets. Value of real-estate (other than employer real property)	2012-12-31	$151,500
Total contributions received or receivable from employer(s)	2012-12-31	$62,177
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$137

Form 5500 Responses for KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN

2016: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: KEITH A. JOHNSON, D.D.S., P.C. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	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

Insurance Providers Used on plan

AVIVA LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 60631 )

Policy contract number

564685

Policy instance

Insurance contract or identification number	564685
Number of Individuals Covered	7
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes

AVIVA LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 60631 )

Policy contract number

564685

Policy instance

Insurance contract or identification number	564685
Number of Individuals Covered	8
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes

AVIVA LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 60631 )

Policy contract number

564685

Policy instance

Insurance contract or identification number	564685
Number of Individuals Covered	10
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes

AVIVA LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 60631 )

Policy contract number

564685

Policy instance

Insurance contract or identification number	564685
Number of Individuals Covered	9
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes

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Company Name:	KEITH A. JOHNSON, D.D.S., P.C.
Employer identification number (EIN):	421193011
NAIC Classification:	621210
NAIC Description:	Offices of Dentists