401k Plan data: KENNETH R. DIBBLE RETIREMENT PLAN plan

KENNETH R. DIBBLE RETIREMENT PLAN 401k Plan overview

Plan Name	KENNETH R. DIBBLE RETIREMENT PLAN
Plan identification number	001

KENNETH R. DIBBLE RETIREMENT 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.
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

KENNETH R. DIBBLE DBA LONE PEAK DENTAL CARE has sponsored the creation of one or more 401k plans.

Company Name: KENNETH R. DIBBLE DBA LONE PEAK DENTAL CARE

Employer identification number (EIN): 710947665

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KENNETH R. DIBBLE RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 KENNETH DIBBLE 2017-05-17 KENNETH DIBBLE 2017-05-17
001 2015-01-01 KENNETH DIBBLE 2016-10-12 KENNETH DIBBLE 2016-10-12
001 2014-01-01 KENNETH DIBBLE 2016-07-15 KENNETH DIBBLE 2016-07-15
001 2013-01-01 KENNETH DIBBLE KENNETH DIBBLE 2014-07-11
001 2012-01-01 KENNETH DIBBLE KENNETH DIBBLE 2013-04-26
001 2011-01-01 KENNETH DIBBLE KENNETH DIBBLE 2012-07-12
001 2010-07-01 KENNETH DIBBLE KENNETH DIBBLE 2011-07-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	KENNETH DIBBLE	2017-05-17	KENNETH DIBBLE	2017-05-17
001	2015-01-01	KENNETH DIBBLE	2016-10-12	KENNETH DIBBLE	2016-10-12
001	2014-01-01	KENNETH DIBBLE	2016-07-15	KENNETH DIBBLE	2016-07-15
001	2013-01-01	KENNETH DIBBLE		KENNETH DIBBLE	2014-07-11
001	2012-01-01	KENNETH DIBBLE		KENNETH DIBBLE	2013-04-26
001	2011-01-01	KENNETH DIBBLE		KENNETH DIBBLE	2012-07-12
001	2010-07-01	KENNETH DIBBLE		KENNETH DIBBLE	2011-07-20

Plan Statistics for KENNETH R. DIBBLE RETIREMENT PLAN

401k plan membership statisitcs for KENNETH R. DIBBLE RETIREMENT PLAN

Measure Date Value
2013: KENNETH R. DIBBLE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 13
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 1
Total of all active and inactive participants 2013-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 14
Number of participants with account balances 2013-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: KENNETH R. DIBBLE 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 12
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 1
Total of all active and inactive participants 2012-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 13
Number of participants with account balances 2012-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: KENNETH R. DIBBLE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 14
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 2
Total of all active and inactive participants 2011-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 16
Number of participants with account balances 2011-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: KENNETH R. DIBBLE RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-07-01 18
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 14
Number of retired or separated participants receiving benefits 2010-07-01 0
Number of other retired or separated participants entitled to future benefits 2010-07-01 1
Total of all active and inactive participants 2010-07-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-07-01 0
Total participants 2010-07-01 15
Number of participants with account balances 2010-07-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-07-01 0

Measure	Date	Value
2013: KENNETH R. DIBBLE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	13
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	1
Total of all active and inactive participants	2013-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	14
Number of participants with account balances	2013-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: KENNETH R. DIBBLE 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	12
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	1
Total of all active and inactive participants	2012-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	13
Number of participants with account balances	2012-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: KENNETH R. DIBBLE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	14
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	2
Total of all active and inactive participants	2011-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	16
Number of participants with account balances	2011-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: KENNETH R. DIBBLE RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-07-01	18
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	14
Number of retired or separated participants receiving benefits	2010-07-01	0
Number of other retired or separated participants entitled to future benefits	2010-07-01	1
Total of all active and inactive participants	2010-07-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-07-01	0
Total participants	2010-07-01	15
Number of participants with account balances	2010-07-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-07-01	0

Financial Data on KENNETH R. DIBBLE RETIREMENT PLAN

Measure	Date	Value
2013 : KENNETH R. DIBBLE RETIREMENT PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$25,429
Expenses. Total of all expenses incurred	2013-12-31	$32,733
Benefits paid (including direct rollovers)	2013-12-31	$31,400
Total plan assets at end of year	2013-12-31	$119,832
Total plan assets at beginning of year	2013-12-31	$127,136
Value of fidelity bond covering the plan	2013-12-31	$20,000
Total contributions received or receivable from participants	2013-12-31	$4,482
Other income received	2013-12-31	$20,947
Net income (gross income less expenses)	2013-12-31	$-7,304
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$119,832
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$127,136
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$1,333
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : KENNETH R. DIBBLE RETIREMENT PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$25,989
Expenses. Total of all expenses incurred	2012-12-31	$77,789
Benefits paid (including direct rollovers)	2012-12-31	$76,254
Total plan assets at end of year	2012-12-31	$127,136
Total plan assets at beginning of year	2012-12-31	$178,936
Value of fidelity bond covering the plan	2012-12-31	$20,000
Total contributions received or receivable from participants	2012-12-31	$5,305
Other income received	2012-12-31	$20,684
Net income (gross income less expenses)	2012-12-31	$-51,800
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$127,136
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$178,936
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$1,535
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : KENNETH R. DIBBLE RETIREMENT PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$1,812
Expenses. Total of all expenses incurred	2011-12-31	$22,136
Benefits paid (including direct rollovers)	2011-12-31	$20,000
Total plan assets at end of year	2011-12-31	$178,936
Total plan assets at beginning of year	2011-12-31	$199,260
Value of fidelity bond covering the plan	2011-12-31	$20,000
Total contributions received or receivable from participants	2011-12-31	$8,126
Other income received	2011-12-31	$-6,314
Net income (gross income less expenses)	2011-12-31	$-20,324
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$178,936
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$199,260
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$2,136
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : KENNETH R. DIBBLE RETIREMENT PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$40,150
Expenses. Total of all expenses incurred	2010-12-31	$26,887
Benefits paid (including direct rollovers)	2010-12-31	$25,733
Total plan assets at end of year	2010-12-31	$199,260
Total plan assets at beginning of year	2010-12-31	$185,997
Total contributions received or receivable from participants	2010-12-31	$4,534
Other income received	2010-12-31	$35,616
Net income (gross income less expenses)	2010-12-31	$13,263
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$199,260
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$185,997
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$1,154
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for KENNETH R. DIBBLE RETIREMENT PLAN

2013: KENNETH R. DIBBLE RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
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 – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: KENNETH R. DIBBLE 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 – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: KENNETH R. DIBBLE 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 – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: KENNETH R. DIBBLE RETIREMENT PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Submission has been amended	No
2010-07-01	This submission is the final filing	No
2010-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2010-07-01	Plan is a collectively bargained plan	No
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

35753

Policy instance

Insurance contract or identification number	35753
Number of Individuals Covered	6
Insurance policy start date	2013-07-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $569
Total amount of fees paid to insurance company	USD $35
Amount paid for insurance broker fees	35
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $569
Insurance broker name	MML INSURANCE AGENCY INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

35753

Policy instance

Insurance contract or identification number	35753
Number of Individuals Covered	6
Insurance policy start date	2012-07-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $642
Total amount of fees paid to insurance company	USD $105
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	105
Additional information about fees paid to insurance broker	ADMINISTRATION FEES
Insurance broker organization code?	5
Insurance broker name	MML INSURANCE AGENCY INC.

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

35753

Policy instance

Insurance contract or identification number	35753
Number of Individuals Covered	15
Insurance policy start date	2011-07-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $953
Total amount of fees paid to insurance company	USD $60

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

35753

Policy instance

Insurance contract or identification number	35753
Number of Individuals Covered	8
Insurance policy start date	2010-07-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $501
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $501
Insurance broker organization code?	3
Insurance broker name	INSPHERE SECURITIES

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Company Name:	KENNETH R. DIBBLE DBA LONE PEAK DENTAL CARE
Employer identification number (EIN):	710947665
NAIC Classification:	621210
NAIC Description:	Offices of Dentists