401k Plan data: RONALD W. FORSBERG, DDS 401(K) PLAN plan

RONALD W. FORSBERG, DDS 401(K) PLAN 401k Plan overview

Plan Name	RONALD W. FORSBERG, DDS 401(K) PLAN
Plan identification number	001

RONALD W. FORSBERG, DDS 401(K) 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.
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

RONALD W. FORSBERG, DDS, P.A. has sponsored the creation of one or more 401k plans.

Company Name: RONALD W. FORSBERG, DDS, P.A.

Employer identification number (EIN): 820486665

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RONALD W. FORSBERG, DDS 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 RONALD W. FORSBERG 2016-12-16
001 2015-01-01 RONALD W. FORSBERG, DDS
001 2014-01-01 RONALD W. FORSBERG, DDS
001 2013-01-01 RONALD W. FORSBERG, DDS
001 2012-01-01 RONALD W. FORSBERG, DDS
001 2011-01-01 RONALD W. FORSBERG, DDS
001 2009-01-01 RONALD W. FORSBERG, DDS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2016-01-01	RONALD W. FORSBERG	2016-12-16
001	2015-01-01	RONALD W. FORSBERG, DDS
001	2014-01-01	RONALD W. FORSBERG, DDS
001	2013-01-01	RONALD W. FORSBERG, DDS
001	2012-01-01	RONALD W. FORSBERG, DDS
001	2011-01-01	RONALD W. FORSBERG, DDS
001	2009-01-01	RONALD W. FORSBERG, DDS

Plan Statistics for RONALD W. FORSBERG, DDS 401(K) PLAN

401k plan membership statisitcs for RONALD W. FORSBERG, DDS 401(K) PLAN

Measure Date Value
2015: RONALD W. FORSBERG, DDS 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 6
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 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 6
Number of participants with account balances 2015-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: RONALD W. FORSBERG, DDS 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 5
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 7
Number of participants with account balances 2014-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: RONALD W. FORSBERG, DDS 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 6
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 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 6
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: RONALD W. FORSBERG, DDS 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 6
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 0
Total of all active and inactive participants 2012-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 6
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: RONALD W. FORSBERG, DDS 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 6
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 0
Total of all active and inactive participants 2011-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 6
Number of participants with account balances 2011-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: RONALD W. FORSBERG, DDS 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 6
Number of retired or separated participants receiving benefits 2009-01-01 1
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 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 7
Number of participants with account balances 2009-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2015: RONALD W. FORSBERG, DDS 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	6
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	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	6
Number of participants with account balances	2015-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: RONALD W. FORSBERG, DDS 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	5
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	7
Number of participants with account balances	2014-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: RONALD W. FORSBERG, DDS 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	6
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	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	6
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: RONALD W. FORSBERG, DDS 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	6
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	0
Total of all active and inactive participants	2012-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	6
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: RONALD W. FORSBERG, DDS 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	6
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	0
Total of all active and inactive participants	2011-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	6
Number of participants with account balances	2011-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: RONALD W. FORSBERG, DDS 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	6
Number of retired or separated participants receiving benefits	2009-01-01	1
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	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	7
Number of participants with account balances	2009-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on RONALD W. FORSBERG, DDS 401(K) PLAN

Measure	Date	Value
2015 : RONALD W. FORSBERG, DDS 401(K) PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$21,617
Expenses. Total of all expenses incurred	2015-12-31	$108,785
Benefits paid (including direct rollovers)	2015-12-31	$102,569
Total plan assets at end of year	2015-12-31	$839,805
Total plan assets at beginning of year	2015-12-31	$926,973
Value of fidelity bond covering the plan	2015-12-31	$100,000
Total contributions received or receivable from participants	2015-12-31	$31,036
Other income received	2015-12-31	$-14,646
Net income (gross income less expenses)	2015-12-31	$-87,168
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$839,805
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$926,973
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$28,713
Total contributions received or receivable from employer(s)	2015-12-31	$5,227
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$6,216
2014 : RONALD W. FORSBERG, DDS 401(K) PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$130,322
Expenses. Total of all expenses incurred	2014-12-31	$9,644
Benefits paid (including direct rollovers)	2014-12-31	$4,175
Total plan assets at end of year	2014-12-31	$926,973
Total plan assets at beginning of year	2014-12-31	$806,295
Value of fidelity bond covering the plan	2014-12-31	$100,000
Total contributions received or receivable from participants	2014-12-31	$34,195
Other income received	2014-12-31	$87,561
Net income (gross income less expenses)	2014-12-31	$120,678
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$926,973
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$806,295
Assets. Value of assets in partnership/joint-venture interests	2014-12-31	$34,557
Total contributions received or receivable from employer(s)	2014-12-31	$8,566
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$5,469
2013 : RONALD W. FORSBERG, DDS 401(K) PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$110,668
Expenses. Total of all expenses incurred	2013-12-31	$4,821
Total plan assets at end of year	2013-12-31	$806,295
Total plan assets at beginning of year	2013-12-31	$700,448
Value of fidelity bond covering the plan	2013-12-31	$100,000
Total contributions received or receivable from participants	2013-12-31	$33,161
Other income received	2013-12-31	$69,036
Net income (gross income less expenses)	2013-12-31	$105,847
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$806,295
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$700,448
Assets. Value of assets in partnership/joint-venture interests	2013-12-31	$10,208
Total contributions received or receivable from employer(s)	2013-12-31	$8,471
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$4,821
2012 : RONALD W. FORSBERG, DDS 401(K) PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$83,781
Expenses. Total of all expenses incurred	2012-12-31	$4,029
Total plan assets at end of year	2012-12-31	$700,448
Total plan assets at beginning of year	2012-12-31	$620,696
Value of fidelity bond covering the plan	2012-12-31	$100,000
Total contributions received or receivable from participants	2012-12-31	$33,559
Other income received	2012-12-31	$41,739
Net income (gross income less expenses)	2012-12-31	$79,752
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$700,448
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$620,696
Assets. Value of assets in partnership/joint-venture interests	2012-12-31	$38,952
Total contributions received or receivable from employer(s)	2012-12-31	$8,483
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$4,029
2011 : RONALD W. FORSBERG, DDS 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$44,654
Expenses. Total of all expenses incurred	2011-12-31	$34,314
Benefits paid (including direct rollovers)	2011-12-31	$30,512
Total plan assets at end of year	2011-12-31	$620,696
Total plan assets at beginning of year	2011-12-31	$610,356
Value of fidelity bond covering the plan	2011-12-31	$65,000
Total contributions received or receivable from participants	2011-12-31	$29,013
Other income received	2011-12-31	$7,731
Net income (gross income less expenses)	2011-12-31	$10,340
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$620,696
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$610,356
Assets. Value of participant loans	2011-12-31	$75
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$112,531
Total contributions received or receivable from employer(s)	2011-12-31	$7,910
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$3,802
2010 : RONALD W. FORSBERG, DDS 401(K) PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$62,693
Expenses. Total of all expenses incurred	2010-12-31	$89,812
Benefits paid (including direct rollovers)	2010-12-31	$86,192
Total plan assets at end of year	2010-12-31	$610,356
Total plan assets at beginning of year	2010-12-31	$637,475
Value of fidelity bond covering the plan	2010-12-31	$65,000
Total contributions received or receivable from participants	2010-12-31	$26,298
Expenses. Other expenses not covered elsewhere	2010-12-31	$3,620
Other income received	2010-12-31	$29,426
Net income (gross income less expenses)	2010-12-31	$-27,119
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$610,356
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$637,475
Assets. Value of participant loans	2010-12-31	$2,496
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$106,823
Total contributions received or receivable from employer(s)	2010-12-31	$6,969

Form 5500 Responses for RONALD W. FORSBERG, DDS 401(K) PLAN

2015: RONALD W. FORSBERG, DDS 401(K) 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: RONALD W. FORSBERG, DDS 401(K) 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: RONALD W. FORSBERG, DDS 401(K) 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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: RONALD W. FORSBERG, DDS 401(K) 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: RONALD W. FORSBERG, DDS 401(K) 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: RONALD W. FORSBERG, DDS 401(K) 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:	RONALD W. FORSBERG, DDS, P.A.
Employer identification number (EIN):	820486665
NAIC Classification:	621210
NAIC Description:	Offices of Dentists