401k Plan data: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST plan

GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 401k Plan overview

Plan Name	GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST
Plan identification number	001

GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 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
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.
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.
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

GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. has sponsored the creation of one or more 401k plans.

Company Name: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C.

Employer identification number (EIN): 391715594

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 R. DALE DAVIS, M.D., FCCP R. DALE DAVIS, M.D., FCCP 2013-02-26
001 2011-01-01 R. DALE DAVIS, M.D., FCCP R. DALE DAVIS, M.D., FCCP 2012-04-12
001 2010-01-01 R. DALE DAVIS, M.D., FCCP R. DALE DAVIS, M.D., FCCP 2011-04-12
001 2009-01-01 R. DALE DAVIS, M.D., FCCP R. DALE DAVIS, M.D., FCCP 2010-07-12
001 2007-01-01 R. DALE DAVIS, M.D., FCCP R. DALE DAVIS, M.D., FCCP 2010-08-11

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2012-01-01	R. DALE DAVIS, M.D., FCCP	R. DALE DAVIS, M.D., FCCP	2013-02-26
001	2011-01-01	R. DALE DAVIS, M.D., FCCP	R. DALE DAVIS, M.D., FCCP	2012-04-12
001	2010-01-01	R. DALE DAVIS, M.D., FCCP	R. DALE DAVIS, M.D., FCCP	2011-04-12
001	2009-01-01	R. DALE DAVIS, M.D., FCCP	R. DALE DAVIS, M.D., FCCP	2010-07-12
001	2007-01-01	R. DALE DAVIS, M.D., FCCP	R. DALE DAVIS, M.D., FCCP	2010-08-11

Plan Statistics for GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST

401k plan membership statisitcs for GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST

Measure Date Value
2012: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 0
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 0
Total of all active and inactive participants 2012-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 0
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 3
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 1
Total of all active and inactive participants 2011-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 4
Number of participants with account balances 2011-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 3
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 4
Total participants 2010-01-01 4
Number of participants with account balances 2010-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2
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 1
Total of all active and inactive participants 2009-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 3
Number of participants with account balances 2009-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1
2007: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2007 401k membership
Total participants, beginning-of-year 2007-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 1
Number of retired or separated participants receiving benefits 2007-01-01 0
Number of other retired or separated participants entitled to future benefits 2007-01-01 0
Total of all active and inactive participants 2007-01-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2007-01-01 0
Total participants 2007-01-01 1
Number of participants with account balances 2007-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2007-01-01 0

Measure	Date	Value
2012: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	0
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	0
Total of all active and inactive participants	2012-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	0
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3
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	1
Total of all active and inactive participants	2011-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	4
Number of participants with account balances	2011-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	3
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	4
Total participants	2010-01-01	4
Number of participants with account balances	2010-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2
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	1
Total of all active and inactive participants	2009-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	3
Number of participants with account balances	2009-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1
2007: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2007 401k membership
Total participants, beginning-of-year	2007-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	1
Number of retired or separated participants receiving benefits	2007-01-01	0
Number of other retired or separated participants entitled to future benefits	2007-01-01	0
Total of all active and inactive participants	2007-01-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2007-01-01	0
Total participants	2007-01-01	1
Number of participants with account balances	2007-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2007-01-01	0

Financial Data on GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST

Measure	Date	Value
2012 : GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2012 401k financial data
Total plan liabilities at end of year	2012-10-31	$0
Total plan liabilities at beginning of year	2012-10-31	$0
Total income from all sources	2012-10-31	$61,543
Expenses. Total of all expenses incurred	2012-10-31	$640,083
Benefits paid (including direct rollovers)	2012-10-31	$639,983
Total plan assets at end of year	2012-10-31	$0
Total plan assets at beginning of year	2012-10-31	$578,540
Value of fidelity bond covering the plan	2012-10-31	$50,000
Total contributions received or receivable from participants	2012-10-31	$0
Expenses. Other expenses not covered elsewhere	2012-10-31	$0
Contributions received from other sources (not participants or employers)	2012-10-31	$0
Other income received	2012-10-31	$61,543
Noncash contributions received	2012-10-31	$0
Net income (gross income less expenses)	2012-10-31	$-578,540
Net plan assets at end of year (total assets less liabilities)	2012-10-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-10-31	$578,540
Total contributions received or receivable from employer(s)	2012-10-31	$0
Value of certain deemed distributions of participant loans	2012-10-31	$0
Value of corrective distributions	2012-10-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-10-31	$100
2011 : GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2011 401k financial data
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	$-17,495
Expenses. Total of all expenses incurred	2011-12-31	$0
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$578,540
Total plan assets at beginning of year	2011-12-31	$596,035
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$154
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	$-26,712
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-17,495
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$578,540
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$596,035
Total contributions received or receivable from employer(s)	2011-12-31	$9,063
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	$0
2010 : GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2010 401k financial data
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	$79,604
Expenses. Total of all expenses incurred	2010-12-31	$41
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$596,035
Total plan assets at beginning of year	2010-12-31	$516,472
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$24,757
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	$20,321
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$79,563
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$596,035
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$516,472
Total contributions received or receivable from employer(s)	2010-12-31	$34,526
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	$41
2009 : GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0
2007 : GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2007 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2007-12-31	$0

Form 5500 Responses for GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST

2012: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 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	Yes
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND 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: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND 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: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 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
2007: GREEN BAY CHEST & INFECTIOUS DISEASES, S.C. RETIREMENT PLAN AND TRUST 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Trust	Yes
2007-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	GREEN BAY CHEST & INFECTIOUS DISEASES, S.C.
Employer identification number (EIN):	391715594
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)