401k Plan data: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN plan

BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN
Plan identification number	001

BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
Participant-directed brokerage accounts provided as an investment option under the plan.
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

BLACK CREEK DENTAL, LLC has sponsored the creation of one or more 401k plans.

Company Name: BLACK CREEK DENTAL, LLC

Employer identification number (EIN): 392033853

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-10-01 THOMAS LORNSON, DDS 2024-07-10
001 2021-10-01 THOMAS LORNSON, DDS 2022-12-22
001 2020-10-01
001 2020-10-01
001 2020-10-01 THOMAS LORNSON, DDS 2022-12-22
001 2019-10-01 THOMAS LORNSON, DDS 2021-07-06
001 2018-10-01 THOMAS LORNSON, DDS 2020-07-13
001 2017-10-01 THOMAS LORNSON 2019-07-08
001 2016-10-01
001 2016-10-01 THOMAS LORNSON 2016-06-07
001 2015-10-01
001 2014-10-01
001 2013-10-01 THOMAS LORNSON
001 2012-10-01 THOMAS LORNSON
001 2011-10-01 THOMAS LORNSON
001 2009-10-01 THOMAS LORNSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-10-01	THOMAS LORNSON, DDS	2024-07-10
001	2021-10-01	THOMAS LORNSON, DDS	2022-12-22
001	2020-10-01
001	2020-10-01
001	2020-10-01	THOMAS LORNSON, DDS	2022-12-22
001	2019-10-01	THOMAS LORNSON, DDS	2021-07-06
001	2018-10-01	THOMAS LORNSON, DDS	2020-07-13
001	2017-10-01	THOMAS LORNSON	2019-07-08
001	2016-10-01
001	2016-10-01	THOMAS LORNSON	2016-06-07
001	2015-10-01
001	2014-10-01
001	2013-10-01	THOMAS LORNSON
001	2012-10-01	THOMAS LORNSON
001	2011-10-01	THOMAS LORNSON
001	2009-10-01	THOMAS LORNSON

Plan Statistics for BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN

Measure Date Value
2022: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-10-01 8
Total number of active participants reported on line 7a of the Form 5500 2022-10-01 7
Number of retired or separated participants receiving benefits 2022-10-01 0
Number of other retired or separated participants entitled to future benefits 2022-10-01 0
Total of all active and inactive participants 2022-10-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-10-01 0
Total participants 2022-10-01 7
Number of participants with account balances 2022-10-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-10-01 0
2021: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 8
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 6
Number of retired or separated participants receiving benefits 2021-10-01 1
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-10-01 0
Total participants 2021-10-01 7
Number of participants with account balances 2021-10-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-10-01 0
2020: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 7
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 7
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-10-01 0
Total participants 2020-10-01 7
Number of participants with account balances 2020-10-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-10-01 0
2019: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 7
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 5
Number of retired or separated participants receiving benefits 2019-10-01 1
Number of other retired or separated participants entitled to future benefits 2019-10-01 1
Total of all active and inactive participants 2019-10-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-10-01 0
Total participants 2019-10-01 7
Number of participants with account balances 2019-10-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-10-01 0
2018: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-10-01 7
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 7
Number of retired or separated participants receiving benefits 2018-10-01 0
Number of other retired or separated participants entitled to future benefits 2018-10-01 0
Total of all active and inactive participants 2018-10-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-10-01 0
Total participants 2018-10-01 7
Number of participants with account balances 2018-10-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-10-01 0
2017: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 7
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 7
Number of retired or separated participants receiving benefits 2017-10-01 0
Number of other retired or separated participants entitled to future benefits 2017-10-01 0
Total of all active and inactive participants 2017-10-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-10-01 0
Total participants 2017-10-01 7
Number of participants with account balances 2017-10-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-10-01 0
2016: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-10-01 7
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 7
Number of retired or separated participants receiving benefits 2016-10-01 0
Number of other retired or separated participants entitled to future benefits 2016-10-01 0
Total of all active and inactive participants 2016-10-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-10-01 0
Total participants 2016-10-01 7
Number of participants with account balances 2016-10-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-10-01 0
2015: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 6
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 6
Number of retired or separated participants receiving benefits 2015-10-01 0
Number of other retired or separated participants entitled to future benefits 2015-10-01 0
Total of all active and inactive participants 2015-10-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-10-01 0
Total participants 2015-10-01 6
Number of participants with account balances 2015-10-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-10-01 0
2014: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 6
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 6
Number of retired or separated participants receiving benefits 2014-10-01 0
Number of other retired or separated participants entitled to future benefits 2014-10-01 0
Total of all active and inactive participants 2014-10-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-10-01 0
Total participants 2014-10-01 6
Number of participants with account balances 2014-10-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-10-01 0
2013: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 6
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 6
Number of retired or separated participants receiving benefits 2013-10-01 0
Number of other retired or separated participants entitled to future benefits 2013-10-01 0
Total of all active and inactive participants 2013-10-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-10-01 0
Total participants 2013-10-01 6
Number of participants with account balances 2013-10-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-10-01 0
2012: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 6
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 6
Number of retired or separated participants receiving benefits 2012-10-01 0
Number of other retired or separated participants entitled to future benefits 2012-10-01 0
Total of all active and inactive participants 2012-10-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-10-01 0
Total participants 2012-10-01 6
Number of participants with account balances 2012-10-01 6
2011: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 6
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 6
Number of retired or separated participants receiving benefits 2011-10-01 0
Number of other retired or separated participants entitled to future benefits 2011-10-01 0
Total of all active and inactive participants 2011-10-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-10-01 0
Total participants 2011-10-01 6
Number of participants with account balances 2011-10-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 0
2009: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 6
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 6
Number of retired or separated participants receiving benefits 2009-10-01 0
Number of other retired or separated participants entitled to future benefits 2009-10-01 0
Total of all active and inactive participants 2009-10-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-10-01 0
Total participants 2009-10-01 6
Number of participants with account balances 2009-10-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-10-01 0

Measure	Date	Value
2022: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-10-01	8
Total number of active participants reported on line 7a of the Form 5500	2022-10-01	7
Number of retired or separated participants receiving benefits	2022-10-01	0
Number of other retired or separated participants entitled to future benefits	2022-10-01	0
Total of all active and inactive participants	2022-10-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-10-01	0
Total participants	2022-10-01	7
Number of participants with account balances	2022-10-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-10-01	0
2021: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	8
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	6
Number of retired or separated participants receiving benefits	2021-10-01	1
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-10-01	0
Total participants	2021-10-01	7
Number of participants with account balances	2021-10-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-10-01	0
2020: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	7
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	7
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-10-01	0
Total participants	2020-10-01	7
Number of participants with account balances	2020-10-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-10-01	0
2019: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	7
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	5
Number of retired or separated participants receiving benefits	2019-10-01	1
Number of other retired or separated participants entitled to future benefits	2019-10-01	1
Total of all active and inactive participants	2019-10-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-10-01	0
Total participants	2019-10-01	7
Number of participants with account balances	2019-10-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-10-01	0
2018: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-10-01	7
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	7
Number of retired or separated participants receiving benefits	2018-10-01	0
Number of other retired or separated participants entitled to future benefits	2018-10-01	0
Total of all active and inactive participants	2018-10-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-10-01	0
Total participants	2018-10-01	7
Number of participants with account balances	2018-10-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-10-01	0
2017: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	7
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	7
Number of retired or separated participants receiving benefits	2017-10-01	0
Number of other retired or separated participants entitled to future benefits	2017-10-01	0
Total of all active and inactive participants	2017-10-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-10-01	0
Total participants	2017-10-01	7
Number of participants with account balances	2017-10-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-10-01	0
2016: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-10-01	7
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	7
Number of retired or separated participants receiving benefits	2016-10-01	0
Number of other retired or separated participants entitled to future benefits	2016-10-01	0
Total of all active and inactive participants	2016-10-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-10-01	0
Total participants	2016-10-01	7
Number of participants with account balances	2016-10-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-10-01	0
2015: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	6
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	6
Number of retired or separated participants receiving benefits	2015-10-01	0
Number of other retired or separated participants entitled to future benefits	2015-10-01	0
Total of all active and inactive participants	2015-10-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-10-01	0
Total participants	2015-10-01	6
Number of participants with account balances	2015-10-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-10-01	0
2014: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	6
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	6
Number of retired or separated participants receiving benefits	2014-10-01	0
Number of other retired or separated participants entitled to future benefits	2014-10-01	0
Total of all active and inactive participants	2014-10-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-10-01	0
Total participants	2014-10-01	6
Number of participants with account balances	2014-10-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-10-01	0
2013: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	6
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	6
Number of retired or separated participants receiving benefits	2013-10-01	0
Number of other retired or separated participants entitled to future benefits	2013-10-01	0
Total of all active and inactive participants	2013-10-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-10-01	0
Total participants	2013-10-01	6
Number of participants with account balances	2013-10-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-10-01	0
2012: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	6
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	6
Number of retired or separated participants receiving benefits	2012-10-01	0
Number of other retired or separated participants entitled to future benefits	2012-10-01	0
Total of all active and inactive participants	2012-10-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-10-01	0
Total participants	2012-10-01	6
Number of participants with account balances	2012-10-01	6
2011: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	6
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	6
Number of retired or separated participants receiving benefits	2011-10-01	0
Number of other retired or separated participants entitled to future benefits	2011-10-01	0
Total of all active and inactive participants	2011-10-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-10-01	0
Total participants	2011-10-01	6
Number of participants with account balances	2011-10-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	0
2009: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	6
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	6
Number of retired or separated participants receiving benefits	2009-10-01	0
Number of other retired or separated participants entitled to future benefits	2009-10-01	0
Total of all active and inactive participants	2009-10-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-10-01	0
Total participants	2009-10-01	6
Number of participants with account balances	2009-10-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-10-01	0

Financial Data on BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2023 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2023 401k financial data
Total income from all sources	2023-09-30	$383,809
Expenses. Total of all expenses incurred	2023-09-30	$5,689
Benefits paid (including direct rollovers)	2023-09-30	$455
Total plan assets at end of year	2023-09-30	$2,233,948
Total plan assets at beginning of year	2023-09-30	$1,855,828
Value of fidelity bond covering the plan	2023-09-30	$200,000
Total contributions received or receivable from participants	2023-09-30	$51,940
Other income received	2023-09-30	$262,601
Net income (gross income less expenses)	2023-09-30	$378,120
Net plan assets at end of year (total assets less liabilities)	2023-09-30	$2,233,948
Net plan assets at beginning of year (total assets less liabilities)	2023-09-30	$1,855,828
Assets. Value of participant loans	2023-09-30	$91,363
Assets. Value of assets in partnership/joint-venture interests	2023-09-30	$94,854
Total contributions received or receivable from employer(s)	2023-09-30	$69,268
Expenses. Administrative service providers (salaries,fees and commissions)	2023-09-30	$5,234
2022 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total income from all sources	2022-09-30	$-162,485
Expenses. Total of all expenses incurred	2022-09-30	$345,786
Benefits paid (including direct rollovers)	2022-09-30	$345,476
Total plan assets at end of year	2022-09-30	$1,855,828
Total plan assets at beginning of year	2022-09-30	$2,364,099
Value of fidelity bond covering the plan	2022-09-30	$200,000
Total contributions received or receivable from participants	2022-09-30	$58,771
Contributions received from other sources (not participants or employers)	2022-09-30	$126,000
Other income received	2022-09-30	$-413,805
Net income (gross income less expenses)	2022-09-30	$-508,271
Net plan assets at end of year (total assets less liabilities)	2022-09-30	$1,855,828
Net plan assets at beginning of year (total assets less liabilities)	2022-09-30	$2,364,099
Assets. Value of participant loans	2022-09-30	$32,400
Assets. Value of assets in partnership/joint-venture interests	2022-09-30	$91,000
Total contributions received or receivable from employer(s)	2022-09-30	$66,549
Expenses. Administrative service providers (salaries,fees and commissions)	2022-09-30	$310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2022-09-30	$0
2021 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources	2021-09-30	$519,527
Expenses. Total of all expenses incurred	2021-09-30	$81,816
Benefits paid (including direct rollovers)	2021-09-30	$81,666
Total plan assets at end of year	2021-09-30	$2,364,099
Total plan assets at beginning of year	2021-09-30	$1,926,388
Value of fidelity bond covering the plan	2021-09-30	$200,000
Total contributions received or receivable from participants	2021-09-30	$57,149
Other income received	2021-09-30	$400,890
Net income (gross income less expenses)	2021-09-30	$437,711
Net plan assets at end of year (total assets less liabilities)	2021-09-30	$2,364,099
Net plan assets at beginning of year (total assets less liabilities)	2021-09-30	$1,926,388
Assets. Value of participant loans	2021-09-30	$30,780
Assets. Value of assets in partnership/joint-venture interests	2021-09-30	$84,112
Total contributions received or receivable from employer(s)	2021-09-30	$61,488
Expenses. Administrative service providers (salaries,fees and commissions)	2021-09-30	$150
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-09-30	$0
2020 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources	2020-09-30	$246,709
Expenses. Total of all expenses incurred	2020-09-30	$161,604
Benefits paid (including direct rollovers)	2020-09-30	$161,344
Total plan assets at end of year	2020-09-30	$1,926,388
Total plan assets at beginning of year	2020-09-30	$1,841,283
Value of fidelity bond covering the plan	2020-09-30	$200,000
Total contributions received or receivable from participants	2020-09-30	$35,937
Other income received	2020-09-30	$152,919
Net income (gross income less expenses)	2020-09-30	$85,105
Net plan assets at end of year (total assets less liabilities)	2020-09-30	$1,926,388
Net plan assets at beginning of year (total assets less liabilities)	2020-09-30	$1,841,283
Assets. Value of participant loans	2020-09-30	$45,342
Assets. Value of assets in partnership/joint-venture interests	2020-09-30	$84,056
Total contributions received or receivable from employer(s)	2020-09-30	$57,853
Expenses. Administrative service providers (salaries,fees and commissions)	2020-09-30	$260
2019 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources	2019-09-30	$110,427
Expenses. Total of all expenses incurred	2019-09-30	$285
Total plan assets at end of year	2019-09-30	$1,841,283
Total plan assets at beginning of year	2019-09-30	$1,731,141
Value of fidelity bond covering the plan	2019-09-30	$185,000
Total contributions received or receivable from participants	2019-09-30	$38,451
Other income received	2019-09-30	$12,154
Net income (gross income less expenses)	2019-09-30	$110,142
Net plan assets at end of year (total assets less liabilities)	2019-09-30	$1,841,283
Net plan assets at beginning of year (total assets less liabilities)	2019-09-30	$1,731,141
Assets. Value of participant loans	2019-09-30	$32,162
Assets. Value of assets in partnership/joint-venture interests	2019-09-30	$84,046
Total contributions received or receivable from employer(s)	2019-09-30	$59,822
Expenses. Administrative service providers (salaries,fees and commissions)	2019-09-30	$285
2017 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total plan liabilities at beginning of year	2017-09-30	$0
Total income from all sources	2017-09-30	$250,319
Expenses. Total of all expenses incurred	2017-09-30	$250
Total plan assets at end of year	2017-09-30	$1,535,718
Total plan assets at beginning of year	2017-09-30	$1,285,649
Value of fidelity bond covering the plan	2017-09-30	$140,000
Total contributions received or receivable from participants	2017-09-30	$45,257
Other income received	2017-09-30	$152,467
Net income (gross income less expenses)	2017-09-30	$250,069
Net plan assets at end of year (total assets less liabilities)	2017-09-30	$1,535,718
Net plan assets at beginning of year (total assets less liabilities)	2017-09-30	$1,285,649
Assets. Value of participant loans	2017-09-30	$64,102
Assets. Value of assets in partnership/joint-venture interests	2017-09-30	$129,763
Total contributions received or receivable from employer(s)	2017-09-30	$52,595
Expenses. Administrative service providers (salaries,fees and commissions)	2017-09-30	$250
2016 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-09-30	$0
Total plan liabilities at beginning of year	2016-09-30	$0
Total income from all sources	2016-09-30	$202,356
Expenses. Total of all expenses incurred	2016-09-30	$285
Total plan assets at end of year	2016-09-30	$1,285,649
Total plan assets at beginning of year	2016-09-30	$1,083,578
Value of fidelity bond covering the plan	2016-09-30	$140,000
Total contributions received or receivable from participants	2016-09-30	$46,800
Other income received	2016-09-30	$104,027
Net income (gross income less expenses)	2016-09-30	$202,071
Net plan assets at end of year (total assets less liabilities)	2016-09-30	$1,285,649
Net plan assets at beginning of year (total assets less liabilities)	2016-09-30	$1,083,578
Assets. Value of participant loans	2016-09-30	$88,673
Assets. Value of assets in partnership/joint-venture interests	2016-09-30	$137,173
Total contributions received or receivable from employer(s)	2016-09-30	$51,529
Expenses. Administrative service providers (salaries,fees and commissions)	2016-09-30	$285
2015 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-09-30	$49,536
Expenses. Total of all expenses incurred	2015-09-30	$285
Total plan assets at end of year	2015-09-30	$1,083,578
Total plan assets at beginning of year	2015-09-30	$1,034,327
Value of fidelity bond covering the plan	2015-09-30	$140,000
Total contributions received or receivable from participants	2015-09-30	$44,375
Other income received	2015-09-30	$-48,130
Net income (gross income less expenses)	2015-09-30	$49,251
Net plan assets at end of year (total assets less liabilities)	2015-09-30	$1,083,578
Net plan assets at beginning of year (total assets less liabilities)	2015-09-30	$1,034,327
Assets. Value of participant loans	2015-09-30	$61,536
Assets. Value of assets in partnership/joint-venture interests	2015-09-30	$129,570
Total contributions received or receivable from employer(s)	2015-09-30	$53,291
Expenses. Administrative service providers (salaries,fees and commissions)	2015-09-30	$285
2014 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-09-30	$149,599
Expenses. Total of all expenses incurred	2014-09-30	$270
Total plan assets at end of year	2014-09-30	$1,034,327
Total plan assets at beginning of year	2014-09-30	$884,998
Value of fidelity bond covering the plan	2014-09-30	$140,000
Total contributions received or receivable from participants	2014-09-30	$29,315
Expenses. Other expenses not covered elsewhere	2014-09-30	$270
Other income received	2014-09-30	$77,340
Net income (gross income less expenses)	2014-09-30	$149,329
Net plan assets at end of year (total assets less liabilities)	2014-09-30	$1,034,327
Net plan assets at beginning of year (total assets less liabilities)	2014-09-30	$884,998
Assets. Value of participant loans	2014-09-30	$51,097
Assets. Value of assets in partnership/joint-venture interests	2014-09-30	$124,230
Total contributions received or receivable from employer(s)	2014-09-30	$42,944
2013 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-09-30	$185,565
Expenses. Total of all expenses incurred	2013-09-30	$100
Total plan assets at end of year	2013-09-30	$884,998
Total plan assets at beginning of year	2013-09-30	$699,533
Value of fidelity bond covering the plan	2013-09-30	$140,000
Total contributions received or receivable from participants	2013-09-30	$48,665
Other income received	2013-09-30	$85,751
Net income (gross income less expenses)	2013-09-30	$185,465
Net plan assets at end of year (total assets less liabilities)	2013-09-30	$884,998
Net plan assets at beginning of year (total assets less liabilities)	2013-09-30	$699,533
Assets. Value of participant loans	2013-09-30	$33,658
Assets. Value of assets in partnership/joint-venture interests	2013-09-30	$108,776
Total contributions received or receivable from employer(s)	2013-09-30	$51,149
Expenses. Administrative service providers (salaries,fees and commissions)	2013-09-30	$100
2012 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-09-30	$142,322
Expenses. Total of all expenses incurred	2012-09-30	$0
Total plan assets at end of year	2012-09-30	$699,533
Total plan assets at beginning of year	2012-09-30	$557,211
Value of fidelity bond covering the plan	2012-09-30	$140,000
Total contributions received or receivable from participants	2012-09-30	$39,600
Other income received	2012-09-30	$89,582
Net income (gross income less expenses)	2012-09-30	$142,322
Net plan assets at end of year (total assets less liabilities)	2012-09-30	$699,533
Net plan assets at beginning of year (total assets less liabilities)	2012-09-30	$557,211
Assets. Value of participant loans	2012-09-30	$45,464
Assets. Value of assets in partnership/joint-venture interests	2012-09-30	$105,069
Total contributions received or receivable from employer(s)	2012-09-30	$13,140
2011 : BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-09-30	$32,854
Expenses. Total of all expenses incurred	2011-09-30	$110,000
Benefits paid (including direct rollovers)	2011-09-30	$110,000
Total plan assets at end of year	2011-09-30	$557,211
Total plan assets at beginning of year	2011-09-30	$634,357
Value of fidelity bond covering the plan	2011-09-30	$140,000
Total contributions received or receivable from participants	2011-09-30	$39,600
Other income received	2011-09-30	$-26,839
Net income (gross income less expenses)	2011-09-30	$-77,146
Net plan assets at end of year (total assets less liabilities)	2011-09-30	$557,211
Net plan assets at beginning of year (total assets less liabilities)	2011-09-30	$634,357
Assets. Value of participant loans	2011-09-30	$23,661
Assets. Value of assets in partnership/joint-venture interests	2011-09-30	$95,993
Total contributions received or receivable from employer(s)	2011-09-30	$20,093
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-09-30	$0

Form 5500 Responses for BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN

2022: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	Submission has been amended	No
2022-10-01	This submission is the final filing	No
2022-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-10-01	Plan is a collectively bargained plan	No
2022-10-01	Plan funding arrangement – Trust	Yes
2022-10-01	Plan benefit arrangement - Trust	Yes
2021: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – Trust	Yes
2021-10-01	Plan benefit arrangement - Trust	Yes
2020: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Submission has been amended	Yes
2020-10-01	This submission is the final filing	No
2020-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-10-01	Plan is a collectively bargained plan	No
2020-10-01	Plan funding arrangement – Trust	Yes
2020-10-01	Plan benefit arrangement - Trust	Yes
2019: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	Submission has been amended	No
2019-10-01	This submission is the final filing	No
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – Trust	Yes
2019-10-01	Plan benefit arrangement - Trust	Yes
2018: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
2018-10-01	Submission has been amended	No
2018-10-01	This submission is the final filing	No
2018-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-10-01	Plan is a collectively bargained plan	No
2018-10-01	Plan funding arrangement – Trust	Yes
2018-10-01	Plan benefit arrangement - Trust	Yes
2017: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Submission has been amended	No
2017-10-01	This submission is the final filing	No
2017-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-10-01	Plan is a collectively bargained plan	No
2017-10-01	Plan funding arrangement – Trust	Yes
2017-10-01	Plan benefit arrangement - Trust	Yes
2016: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	Yes
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Trust	Yes
2016-10-01	Plan benefit arrangement - Trust	Yes
2015: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Trust	Yes
2015-10-01	Plan benefit arrangement - Trust	Yes
2014: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Trust	Yes
2014-10-01	Plan benefit arrangement - Trust	Yes
2013: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Trust	Yes
2013-10-01	Plan benefit arrangement - Trust	Yes
2012: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Trust	Yes
2012-10-01	Plan benefit arrangement - Trust	Yes
2011: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Trust	Yes
2011-10-01	Plan benefit arrangement - Trust	Yes
2009: BLACK CREEK DENTAL, LLC 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Trust	Yes
2009-10-01	Plan benefit arrangement - Trust	Yes

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Company Name:	BLACK CREEK DENTAL, LLC
Employer identification number (EIN):	392033853
NAIC Classification:	621210
NAIC Description:	Offices of Dentists