401k Plan data: EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN plan

EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 401k Plan overview

Plan Name	EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN
Plan identification number	001

EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT 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
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.
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 contribtions 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.
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

EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. has sponsored the creation of one or more 401k plans.

Company Name: EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC.

Employer identification number (EIN): 050433195

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 EDWARD S KATZ 2023-03-31 EDWARD S KATZ 2023-03-31
001 2021-01-01 EDWARD S KATZ 2022-10-12 EDWARD S KATZ 2022-10-12
001 2020-01-01 EDWARD S KATZ 2021-07-22 EDWARD S KATZ 2021-07-22
001 2019-01-01 EDWARD KATZ 2020-09-09 EDWARD KATZ 2020-09-09
001 2018-01-01 EDWARD KATZ 2019-07-28 EDWARD KATZ 2019-07-28
001 2017-01-01 EDWARD KATZ 2018-09-27 EDWARD KATZ 2018-09-27
001 2016-01-01 EDWARD KATZ 2017-07-05 EDWARD KATZ 2017-07-05
001 2015-01-01 EDWARD KATZ 2016-10-13 EDWARD KATZ 2016-10-13
001 2014-01-01 EDWARD KATZ 2015-06-26 EDWARD KATZ 2015-06-26
001 2013-01-01 EDWARD KATZ 2014-10-14 EDWARD KATZ 2014-10-14
001 2012-01-01 EDWARD KATZ EDWARD KATZ 2013-05-14
001 2011-01-01 EDWARD KATZ EDWARD KATZ 2012-05-08
001 2009-01-01 EDWARD KATZ EDWARD KATZ 2010-09-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	EDWARD S KATZ	2023-03-31	EDWARD S KATZ	2023-03-31
001	2021-01-01	EDWARD S KATZ	2022-10-12	EDWARD S KATZ	2022-10-12
001	2020-01-01	EDWARD S KATZ	2021-07-22	EDWARD S KATZ	2021-07-22
001	2019-01-01	EDWARD KATZ	2020-09-09	EDWARD KATZ	2020-09-09
001	2018-01-01	EDWARD KATZ	2019-07-28	EDWARD KATZ	2019-07-28
001	2017-01-01	EDWARD KATZ	2018-09-27	EDWARD KATZ	2018-09-27
001	2016-01-01	EDWARD KATZ	2017-07-05	EDWARD KATZ	2017-07-05
001	2015-01-01	EDWARD KATZ	2016-10-13	EDWARD KATZ	2016-10-13
001	2014-01-01	EDWARD KATZ	2015-06-26	EDWARD KATZ	2015-06-26
001	2013-01-01	EDWARD KATZ	2014-10-14	EDWARD KATZ	2014-10-14
001	2012-01-01	EDWARD KATZ		EDWARD KATZ	2013-05-14
001	2011-01-01	EDWARD KATZ		EDWARD KATZ	2012-05-08
001	2009-01-01	EDWARD KATZ		EDWARD KATZ	2010-09-23

Plan Statistics for EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN

401k plan membership statisitcs for EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN

Measure Date Value
2012: EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 16
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 14
Number of other retired or separated participants entitled to future benefits 2012-01-01 2
Total of all active and inactive participants 2012-01-01 16
Total participants 2012-01-01 16
Number of participants with account balances 2012-01-01 16
2011: EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 14
Number of other retired or separated participants entitled to future benefits 2011-01-01 2
Total of all active and inactive participants 2011-01-01 16
Total participants 2011-01-01 16
Number of participants with account balances 2011-01-01 16
2009: EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 15
Number of other retired or separated participants entitled to future benefits 2009-01-01 2
Total of all active and inactive participants 2009-01-01 17
Total participants 2009-01-01 17
Number of participants with account balances 2009-01-01 17

Measure	Date	Value
2012: EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	16
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	14
Number of other retired or separated participants entitled to future benefits	2012-01-01	2
Total of all active and inactive participants	2012-01-01	16
Total participants	2012-01-01	16
Number of participants with account balances	2012-01-01	16
2011: EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	14
Number of other retired or separated participants entitled to future benefits	2011-01-01	2
Total of all active and inactive participants	2011-01-01	16
Total participants	2011-01-01	16
Number of participants with account balances	2011-01-01	16
2009: EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	15
Number of other retired or separated participants entitled to future benefits	2009-01-01	2
Total of all active and inactive participants	2009-01-01	17
Total participants	2009-01-01	17
Number of participants with account balances	2009-01-01	17

Financial Data on EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN

Measure	Date	Value
2012 : EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$376,988
Expenses. Total of all expenses incurred	2012-12-31	$13,626
Benefits paid (including direct rollovers)	2012-12-31	$13,526
Total plan assets at end of year	2012-12-31	$2,837,788
Total plan assets at beginning of year	2012-12-31	$2,474,426
Value of fidelity bond covering the plan	2012-12-31	$300,000
Total contributions received or receivable from participants	2012-12-31	$25,160
Other income received	2012-12-31	$255,733
Net income (gross income less expenses)	2012-12-31	$363,362
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,837,788
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,474,426
Total contributions received or receivable from employer(s)	2012-12-31	$96,095
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$100
2011 : EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$52,112
Expenses. Total of all expenses incurred	2011-12-31	$15,461
Benefits paid (including direct rollovers)	2011-12-31	$15,461
Total plan assets at end of year	2011-12-31	$2,474,426
Total plan assets at beginning of year	2011-12-31	$2,437,775
Value of fidelity bond covering the plan	2011-12-31	$300,000
Total contributions received or receivable from participants	2011-12-31	$20,463
Other income received	2011-12-31	$-64,249
Net income (gross income less expenses)	2011-12-31	$36,651
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,474,426
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,437,775
Total contributions received or receivable from employer(s)	2011-12-31	$95,898
2010 : EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$307,743
Expenses. Total of all expenses incurred	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$2,437,775
Total plan assets at beginning of year	2010-12-31	$2,130,032
Value of fidelity bond covering the plan	2010-12-31	$300,000
Total contributions received or receivable from participants	2010-12-31	$6,717
Other income received	2010-12-31	$202,973
Net income (gross income less expenses)	2010-12-31	$307,743
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,437,775
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,130,032
Total contributions received or receivable from employer(s)	2010-12-31	$98,053

Form 5500 Responses for EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN

2012: EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 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
2009: EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC. RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
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:	EDWARD S. KATZ, D.D.S. AND GREGORY S. THEBERGE, D.M.D., INC.
Employer identification number (EIN):	050433195
NAIC Classification:	621210
NAIC Description:	Offices of Dentists