401k Plan data: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN plan

DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN 401k Plan overview

Plan Name	DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN
Plan identification number	001

DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
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).
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

DR. JOHN O. SMITH, OPTOMETRIST PC has sponsored the creation of one or more 401k plans.

Company Name: DR. JOHN O. SMITH, OPTOMETRIST PC

Employer identification number (EIN): 462803290

NAIC Classification: 621320
NAIC Description: Offices of Optometrists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 JOHN SMITH JOHN SMITH 2016-09-20
001 2015-01-01 JOHN SMITH JOHN SMITH 2016-09-20
001 2014-01-01 JOHN SMITH JOHN SMITH 2015-08-27
001 2013-01-01 JOHN SMITH JOHN SMITH 2014-10-13

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	JOHN SMITH	JOHN SMITH	2016-09-20
001	2015-01-01	JOHN SMITH	JOHN SMITH	2016-09-20
001	2014-01-01	JOHN SMITH	JOHN SMITH	2015-08-27
001	2013-01-01	JOHN SMITH	JOHN SMITH	2014-10-13

Plan Statistics for DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN

401k plan membership statisitcs for DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN

Measure Date Value
2016: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1
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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1
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 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 4
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 4
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 0
Total of all active and inactive participants 2013-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2016: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1
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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1
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	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	4
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	4
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	0
Total of all active and inactive participants	2013-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Financial Data on DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN

Measure	Date	Value
2016 : DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN 2016 401k financial data
Transfers to/from the plan	2016-02-02	$0
Total plan liabilities at end of year	2016-02-02	$0
Total plan liabilities at beginning of year	2016-02-02	$0
Total income from all sources	2016-02-02	$-3,930
Expenses. Total of all expenses incurred	2016-02-02	$39,086
Benefits paid (including direct rollovers)	2016-02-02	$38,978
Total plan assets at end of year	2016-02-02	$0
Total plan assets at beginning of year	2016-02-02	$43,016
Total contributions received or receivable from participants	2016-02-02	$0
Expenses. Other expenses not covered elsewhere	2016-02-02	$0
Contributions received from other sources (not participants or employers)	2016-02-02	$0
Other income received	2016-02-02	$-3,930
Noncash contributions received	2016-02-02	$0
Net income (gross income less expenses)	2016-02-02	$-43,016
Net plan assets at end of year (total assets less liabilities)	2016-02-02	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-02-02	$43,016
Total contributions received or receivable from employer(s)	2016-02-02	$0
Value of certain deemed distributions of participant loans	2016-02-02	$0
Value of corrective distributions	2016-02-02	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-02-02	$108
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-02-02	$0
2015 : DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION 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	$-24,228
Expenses. Total of all expenses incurred	2015-12-31	$14,676
Benefits paid (including direct rollovers)	2015-12-31	$13,025
Total plan assets at end of year	2015-12-31	$43,016
Total plan assets at beginning of year	2015-12-31	$81,920
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-24,228
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-38,904
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$43,016
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$81,920
Total contributions received or receivable from employer(s)	2015-12-31	$0
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	$1,651
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION 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	$23,030
Expenses. Total of all expenses incurred	2014-12-31	$999
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$81,920
Total plan assets at beginning of year	2014-12-31	$59,889
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$-970
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$22,031
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$81,920
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$59,889
Total contributions received or receivable from employer(s)	2014-12-31	$24,000
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	$999
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION 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	$60,000
Expenses. Total of all expenses incurred	2013-12-31	$111
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$59,889
Total plan assets at beginning of year	2013-12-31	$0
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$0
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$59,889
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$59,889
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$60,000
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	$111
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0

Form 5500 Responses for DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN

2016: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION 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)	Yes
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: DR. JOHN O. SMITH, OPTOMETRIST PC DEFINED BENEFIT PENSION PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	DR. JOHN O. SMITH, OPTOMETRIST PC
Employer identification number (EIN):	462803290
NAIC Classification:	621320
NAIC Description:	Offices of Optometrists