401k Plan data: JEFFREY N. HOLMBERG, D.D.S. 401K PROFIT SHARING PLAN plan

JEFFREY N. HOLMBERG, D.D.S. 401K PROFIT SHARING PLAN 401k Plan overview

Plan Name	JEFFREY N. HOLMBERG, D.D.S. 401K PROFIT SHARING PLAN
Plan identification number	001

JEFFREY N. HOLMBERG, D.D.S. 401K 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
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

JEFFREY N. HOLMBERG, D.D.S. has sponsored the creation of one or more 401k plans.

Company Name: JEFFREY N. HOLMBERG, D.D.S.

Employer identification number (EIN): 363600524

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JEFFREY N. HOLMBERG, D.D.S. 401K 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 JEFFREY N HOLMBERG 2016-08-31
001 2015-01-01 JEFFREY N HOLMBERG 2016-05-19
001 2014-01-01 JEFFREY N HOLMBERG 2015-05-29
001 2013-01-01 JEFFREY N HOLMBERG 2014-06-24
001 2012-01-01 JEFFREY N HOLMBERG 2013-07-24
001 2011-01-01 JEFFREY N HOLMBERG 2012-09-28
001 2010-01-01 JEFFREY N HOLMBERG 2011-10-05
001 2009-01-01 JEFFREY N. HOLMBERG JEFFREY N. HOLMBERG 2010-10-05

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	JEFFREY N HOLMBERG	2016-08-31
001	2015-01-01	JEFFREY N HOLMBERG	2016-05-19
001	2014-01-01	JEFFREY N HOLMBERG	2015-05-29
001	2013-01-01	JEFFREY N HOLMBERG	2014-06-24
001	2012-01-01	JEFFREY N HOLMBERG	2013-07-24
001	2011-01-01	JEFFREY N HOLMBERG	2012-09-28
001	2010-01-01	JEFFREY N HOLMBERG	2011-10-05
001	2009-01-01	JEFFREY N. HOLMBERG		JEFFREY N. HOLMBERG	2010-10-05

Plan Statistics for JEFFREY N. HOLMBERG, D.D.S. 401K PROFIT SHARING PLAN

401k plan membership statisitcs for JEFFREY N. HOLMBERG, D.D.S. 401K PROFIT SHARING PLAN

Measure Date Value
2009: JEFFREY N. HOLMBERG, D.D.S. 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 8
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 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 8
Number of participants with account balances 2009-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2009: JEFFREY N. HOLMBERG, D.D.S. 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	8
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	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	8
Number of participants with account balances	2009-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Form 5500 Responses for JEFFREY N. HOLMBERG, D.D.S. 401K PROFIT SHARING PLAN

2009: JEFFREY N. HOLMBERG, D.D.S. 401K PROFIT SHARING 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:	JEFFREY N. HOLMBERG, D.D.S.
Employer identification number (EIN):	363600524
NAIC Classification:	621210
NAIC Description:	Offices of Dentists