401k Plan data: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN plan

TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 401k Plan overview

Plan Name	TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN
Plan identification number	002

TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Profit-sharing

401k Sponsoring company profile

TERRY W. FORSBERG, D.D.S., A.P.C. has sponsored the creation of one or more 401k plans.

Company Name: TERRY W. FORSBERG, D.D.S., A.P.C.

Employer identification number (EIN): 942592292

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2013-02-01 MENKE
002 2012-02-01 MENKE
002 2011-02-01 MENKE
002 2010-02-01 MENKE
002 2009-02-01 MENKE

Plan id#	Filing Submission Date	Name of Administrator
002	2013-02-01	MENKE
002	2012-02-01	MENKE
002	2011-02-01	MENKE
002	2010-02-01	MENKE
002	2009-02-01	MENKE

Plan Statistics for TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN

401k plan membership statisitcs for TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN

Measure Date Value
2013: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-02-01 7
Total number of active participants reported on line 7a of the Form 5500 2013-02-01 0
Number of retired or separated participants receiving benefits 2013-02-01 0
Number of other retired or separated participants entitled to future benefits 2013-02-01 0
Total of all active and inactive participants 2013-02-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-02-01 0
Total participants 2013-02-01 0
Number of participants with account balances 2013-02-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-02-01 0
2012: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-02-01 7
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 4
Number of retired or separated participants receiving benefits 2012-02-01 0
Number of other retired or separated participants entitled to future benefits 2012-02-01 2
Total of all active and inactive participants 2012-02-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-02-01 1
Total participants 2012-02-01 7
Number of participants with account balances 2012-02-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-02-01 0
2011: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-02-01 7
Total number of active participants reported on line 7a of the Form 5500 2011-02-01 4
Number of retired or separated participants receiving benefits 2011-02-01 0
Number of other retired or separated participants entitled to future benefits 2011-02-01 2
Total of all active and inactive participants 2011-02-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-02-01 1
Total participants 2011-02-01 7
Number of participants with account balances 2011-02-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-02-01 0
2010: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-02-01 7
Total number of active participants reported on line 7a of the Form 5500 2010-02-01 4
Number of retired or separated participants receiving benefits 2010-02-01 0
Number of other retired or separated participants entitled to future benefits 2010-02-01 2
Total of all active and inactive participants 2010-02-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-02-01 1
Total participants 2010-02-01 7
Number of participants with account balances 2010-02-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-02-01 0
2009: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-02-01 7
Total number of active participants reported on line 7a of the Form 5500 2009-02-01 4
Number of retired or separated participants receiving benefits 2009-02-01 0
Number of other retired or separated participants entitled to future benefits 2009-02-01 2
Total of all active and inactive participants 2009-02-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-02-01 1
Total participants 2009-02-01 7
Number of participants with account balances 2009-02-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-02-01 0

Measure	Date	Value
2013: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-02-01	7
Total number of active participants reported on line 7a of the Form 5500	2013-02-01	0
Number of retired or separated participants receiving benefits	2013-02-01	0
Number of other retired or separated participants entitled to future benefits	2013-02-01	0
Total of all active and inactive participants	2013-02-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-02-01	0
Total participants	2013-02-01	0
Number of participants with account balances	2013-02-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-02-01	0
2012: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-02-01	7
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	4
Number of retired or separated participants receiving benefits	2012-02-01	0
Number of other retired or separated participants entitled to future benefits	2012-02-01	2
Total of all active and inactive participants	2012-02-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-02-01	1
Total participants	2012-02-01	7
Number of participants with account balances	2012-02-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-02-01	0
2011: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-02-01	7
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	4
Number of retired or separated participants receiving benefits	2011-02-01	0
Number of other retired or separated participants entitled to future benefits	2011-02-01	2
Total of all active and inactive participants	2011-02-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-02-01	1
Total participants	2011-02-01	7
Number of participants with account balances	2011-02-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-02-01	0
2010: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-02-01	7
Total number of active participants reported on line 7a of the Form 5500	2010-02-01	4
Number of retired or separated participants receiving benefits	2010-02-01	0
Number of other retired or separated participants entitled to future benefits	2010-02-01	2
Total of all active and inactive participants	2010-02-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-02-01	1
Total participants	2010-02-01	7
Number of participants with account balances	2010-02-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-02-01	0
2009: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-02-01	7
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	4
Number of retired or separated participants receiving benefits	2009-02-01	0
Number of other retired or separated participants entitled to future benefits	2009-02-01	2
Total of all active and inactive participants	2009-02-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-02-01	1
Total participants	2009-02-01	7
Number of participants with account balances	2009-02-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-02-01	0

Financial Data on TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN

Measure	Date	Value
2014 : TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-01-31	$51,861
Expenses. Total of all expenses incurred	2014-01-31	$300,738
Benefits paid (including direct rollovers)	2014-01-31	$288,320
Total plan assets at end of year	2014-01-31	$0
Total plan assets at beginning of year	2014-01-31	$248,877
Value of fidelity bond covering the plan	2014-01-31	$25,000
Expenses. Other expenses not covered elsewhere	2014-01-31	$12,418
Other income received	2014-01-31	$51,861
Net income (gross income less expenses)	2014-01-31	$-248,877
Net plan assets at end of year (total assets less liabilities)	2014-01-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2014-01-31	$248,877
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-01-31	$0
2013 : TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-01-31	$35,283
Expenses. Total of all expenses incurred	2013-01-31	$2,178
Total plan assets at end of year	2013-01-31	$248,877
Total plan assets at beginning of year	2013-01-31	$215,772
Value of fidelity bond covering the plan	2013-01-31	$25,000
Expenses. Other expenses not covered elsewhere	2013-01-31	$2,178
Other income received	2013-01-31	$35,283
Net income (gross income less expenses)	2013-01-31	$33,105
Net plan assets at end of year (total assets less liabilities)	2013-01-31	$248,877
Net plan assets at beginning of year (total assets less liabilities)	2013-01-31	$215,772
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-01-31	$0
2012 : TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-01-31	$10,301
Expenses. Total of all expenses incurred	2012-01-31	$51,811
Total plan assets at end of year	2012-01-31	$215,772
Total plan assets at beginning of year	2012-01-31	$257,282
Value of fidelity bond covering the plan	2012-01-31	$25,000
Expenses. Other expenses not covered elsewhere	2012-01-31	$4,152
Other income received	2012-01-31	$10,301
Net income (gross income less expenses)	2012-01-31	$-41,510
Net plan assets at end of year (total assets less liabilities)	2012-01-31	$215,772
Net plan assets at beginning of year (total assets less liabilities)	2012-01-31	$257,282
Value of certain deemed distributions of participant loans	2012-01-31	$47,659
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-01-31	$0
2011 : TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-01-31	$12,214
Expenses. Total of all expenses incurred	2011-01-31	$2,032
Total plan assets at end of year	2011-01-31	$257,282
Total plan assets at beginning of year	2011-01-31	$247,100
Value of fidelity bond covering the plan	2011-01-31	$25,000
Expenses. Other expenses not covered elsewhere	2011-01-31	$2,032
Other income received	2011-01-31	$12,214
Net income (gross income less expenses)	2011-01-31	$10,182
Net plan assets at end of year (total assets less liabilities)	2011-01-31	$257,282
Net plan assets at beginning of year (total assets less liabilities)	2011-01-31	$247,100
Assets. Value of participant loans	2011-01-31	$47,659
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-01-31	$0
2010 : TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-01-31	$0

Form 5500 Responses for TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN

2013: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2013 form 5500 responses
2013-02-01	Type of plan entity	Single employer plan
2013-02-01	Submission has been amended	No
2013-02-01	This submission is the final filing	Yes
2013-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-02-01	Plan is a collectively bargained plan	No
2013-02-01	Plan funding arrangement – Trust	Yes
2013-02-01	Plan benefit arrangement - Trust	Yes
2012: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2012 form 5500 responses
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	Submission has been amended	No
2012-02-01	This submission is the final filing	No
2012-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-02-01	Plan is a collectively bargained plan	No
2012-02-01	Plan funding arrangement – Trust	Yes
2012-02-01	Plan benefit arrangement - Trust	Yes
2011: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	Submission has been amended	No
2011-02-01	This submission is the final filing	No
2011-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-02-01	Plan is a collectively bargained plan	No
2011-02-01	Plan funding arrangement – Trust	Yes
2011-02-01	Plan benefit arrangement - Trust	Yes
2010: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2010 form 5500 responses
2010-02-01	Type of plan entity	Single employer plan
2010-02-01	Submission has been amended	No
2010-02-01	This submission is the final filing	No
2010-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-02-01	Plan is a collectively bargained plan	No
2010-02-01	Plan funding arrangement – Trust	Yes
2010-02-01	Plan benefit arrangement - Trust	Yes
2009: TERRY W. FORSBERG, D.D.S., A.P.C. PROFIT SHARING PLAN 2009 form 5500 responses
2009-02-01	Type of plan entity	Single employer plan
2009-02-01	Submission has been amended	No
2009-02-01	This submission is the final filing	No
2009-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-02-01	Plan is a collectively bargained plan	No
2009-02-01	Plan funding arrangement – Trust	Yes
2009-02-01	Plan benefit arrangement - Trust	Yes

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Company Name:	TERRY W. FORSBERG, D.D.S., A.P.C.
Employer identification number (EIN):	942592292
NAIC Classification:	621210
NAIC Description:	Offices of Dentists