Civic Intelligence
Filing

Forestream Dental Group Profit Sharing Plan and Trust

Forestream Dental Group • EIN 16-1404708 • Plan year 2004

Company ProfileSource Archive
Filing Insights

Participants

Down

7 → 6

-1 • -14.29%

Assets

Up

$93,929 → $134,891

$40,962 • 43.61%

Investment Management Fee

-

Admin expenses - • Total expenses $0

Filing Details

Context
Net investment result
$40,962

Status Flags

Fidelity bond in place

No

Limited-scope audit performed

Not reported

Contributions transmitted on time

Not reported

Participant loans in default

No

Leases in default

No

Reportable party-in-interest issues

Not reported

Loss discovered during year

No

Assets with undetermined value

No

Non-cash contributions

No

Assets held for investment

Not reported

5% transactions reported

Not reported

All plan assets distributed

No

Benefits paid when due

Not reported

Plan blackout period

Not reported

Plan termination resolution adopted

No

Counterparties

Company Timeline

This filing is highlighted inside the broader sponsor history.

Year / FilingFilingsParticipantsAssetsContributionsContrib./Participant
200515$160,238$20,000$4,000iApproximate average salary by contribution assumption: employee only about $100,000 at 4% or $66,667 at 6%; with 50% employer match about $66,667 at 4% or $44,444 at 6%; with 100% employer match about $50,000 at 4% or $33,333 at 6%.
Forestream Dental Group Profit Sharing Plan and Trust-5$160,238$20,000$4,000iApproximate average salary by contribution assumption: employee only about $100,000 at 4% or $66,667 at 6%; with 50% employer match about $66,667 at 4% or $44,444 at 6%; with 100% employer match about $50,000 at 4% or $33,333 at 6%.
200416$134,891$16,114$2,686iApproximate average salary by contribution assumption: employee only about $67,142 at 4% or $44,761 at 6%; with 50% employer match about $44,761 at 4% or $29,841 at 6%; with 100% employer match about $33,571 at 4% or $22,381 at 6%.
Forestream Dental Group Profit Sharing Plan and TrustCurrent6$134,891$16,114$2,686iApproximate average salary by contribution assumption: employee only about $67,142 at 4% or $44,761 at 6%; with 50% employer match about $44,761 at 4% or $29,841 at 6%; with 100% employer match about $33,571 at 4% or $22,381 at 6%.
200315$0$0-
Forestream Dental Group Profit Sharing Plan and Trust-5---
200216$69,706$12,500$2,083iApproximate average salary by contribution assumption: employee only about $52,083 at 4% or $34,722 at 6%; with 50% employer match about $34,722 at 4% or $23,148 at 6%; with 100% employer match about $26,042 at 4% or $17,361 at 6%.
Forestream Dental Group Profit Sharing Plan and Trust-6$69,706$12,500$2,083iApproximate average salary by contribution assumption: employee only about $52,083 at 4% or $34,722 at 6%; with 50% employer match about $34,722 at 4% or $23,148 at 6%; with 100% employer match about $26,042 at 4% or $17,361 at 6%.
200114$0$0-
Forestream Dental Group Profit Sharing Plan and Trust-4---
200014$0$0-
Forestream Dental Group Profit Sharing Plan and Trust-4---
199913$48,055$11,581$3,860iApproximate average salary by contribution assumption: employee only about $96,508 at 4% or $64,339 at 6%; with 50% employer match about $64,339 at 4% or $42,893 at 6%; with 100% employer match about $48,254 at 4% or $32,169 at 6%.
Forestream Dental Group Profit Sharing Plan and Trust-3$48,055$11,581$3,860iApproximate average salary by contribution assumption: employee only about $96,508 at 4% or $64,339 at 6%; with 50% employer match about $64,339 at 4% or $42,893 at 6%; with 100% employer match about $48,254 at 4% or $32,169 at 6%.
Schedule Details

Schedule A

Row 1
Filing Id
84037236078295
Form Id
60685410
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
4020375236078040002
Ins Broker 01 Name
NO COMMISSIONS TO REPORT
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Ins Broker Fees Pd 01 Text
N/A
Ins Broker 01 Code
3
Row 2
Filing Id
84037236078295
Form Id
60685410
Page Id
2
Page Seq
0
Page Row Num
2
Row Num
1
Image Form Id
4020375236078040002
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Ins Broker Fees Pd 01 Text
N/A
Row 3
Filing Id
84037236078295
Form Id
60685410
Page Id
2
Page Seq
0
Page Row Num
3
Row Num
2
Image Form Id
4020375236078040002
Ins Broker Comm Pd 01 Amount
$0
Ins Broker Fees Pd 01 Amount
$0
Ins Broker Fees Pd 01 Text
N/A
Row 4
Ins Carrier Name: NATIONAL LIFE INSURANCE COMPANY
Filing Id
84037236078295
Form Id
60685410
Schedule A EIN
16-1404708
Schedule A Plan Num
1
Schedule A Plan Year Begin Date
2004-01-01
Schedule A Tax Period
20041231
Ins Carrier Name
NATIONAL LIFE INSURANCE COMPANY
Ins Carrier EIN
30144090
Ins Carrier Naic Code
66680
Ins Contract Num
0196410
Ins Prsn Covered End of year Count
1
Ins Policy From Date
N/A
Ins Broker Comm Total Amount
$0
Ins Broker Fees Total Amount
$0
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Basis Rates Text
BASED ON SCHEDULES FILED W/STATE
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension Type Alloc Cntrct Indicator
Yes
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0

Schedule I

Schedule I Financial Statement

Small plan result

Balance sheet and activity values reported by the filer for this small-plan annual return.

End-of-year assets$134,891$40,962 change

Balance Sheet

Beginning and end of plan year.

Total assets$93,929$134,891Increase +$40,962 (43.61%)
Total liabilities$0$0No change $0
Net assets$93,929$134,891Increase +$40,962 (43.61%)

Contributions

Employer contributions$16,114
Participant contributions$0
Other contributions$0

Income & Expenses

Total income$40,962
Total expenses$0
Net income$40,962
Source fields
Schedule I source fields
Filing Id
84037236078295
Schedule I EIN
16-1404708
Schedule I Plan Num
001
Schedule I Plan Year Begin Date
2004-01-01
Schedule I Tax Period
20041231
Small plan total assets at beginning of year
$93,929
Small plan total liabilities at beginning of year
$0
Small plan net assets at beginning of year
$93,929
Small plan total assets at end of year
$134,891
Small plan total liabilities at end of year
$0
Small plan net assets at end of year
$134,891
Small plan employer contributions
$16,114
Small plan participant contributions
$0
Small Oth Contribution Rcvd Amount
$0
Small Non Cash Contribution Bs Amount
$0
Small Other Income Amount
$24,848
Small plan total income
$40,962
Small plan total benefit distributions
$0
Small Corrective Distribution Amount
$0
Small Dm Dstrb Ptcp Ln A
0
Small Oth Expenses Amount
$0
Small plan total expenses
$0
Small plan net income or loss
$40,962
Small Total Plan Transfers Amount
$0
Small Joint Venture End of year Indicator
No
Small Joint Venture End of year Amount
$0
Small Employer Prop End of year Indicator
No
Small Employer Prop End of year Amount
$0
Small Investment Real Est End of year I
2
Small Investment Real Est End of year A
0
Small Employer Sec End of year Indicator
No
Small Employer Sec End of year Amount
$0
Small Mortg Participants End of year Indicator
Yes
Small Mortg Participants End of year Amount
$25,102
Small Oth Lns Participants End of year Indicator
No
Small Oth Lns Participants End of year Amount
$0
Small Personal Prop End of year Indicator
No
Small Personal Prop End of year Amount
$0
Small Fail Xmt Ctb I
2
Small Fail Xmt Ctb A
0
Small plan participant loans in default
No
Small Loans In Default Amount
$0
Small plan leases in default
No
Small Leases In Default Amount
$0
Small Pt In Interest Not Reported I
2
Small Pt In Interest Not Reported A
0
Small plan fidelity bond in place
No
Small plan fidelity bond amount
$0
Small plan loss discovered during year
No
Small Loss Discovered Dur Year Amount
$0
Small plan assets with undetermined value
No
Small Asset Undeterm Valuation Amount
$0
Small plan non-cash contributions reported
No
Small Non Cash Contribution Amount
$0
Small 20 Percent Sngl Investment Indicator
No
Small 20 Percent Sngl Investment Amount
$0
Small plan all plan assets distributed
No
Waiver Annual Iqpa Report
1
Small plan resolution to terminate plan adopted
No
Small Res Terminate Plan Adpt Amount
$0