401k Plan data: ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN plan

ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 401k Plan overview

Plan Name	ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN
Plan identification number	001

ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN Benefits

401k Plan Type	Defined Benefit Pension
Plan Features/Benefits	Benefits are primarily pay related 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

R. SCOTT FISHER, D.D.S., INC. has sponsored the creation of one or more 401k plans.

Company Name: R. SCOTT FISHER, D.D.S., INC.

Employer identification number (EIN): 460787568

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01
001 2015-01-01
001 2014-01-01 ROBERT SCOTT FISHER
001 2013-01-01 ROBERT SCOTT FISHER 2014-02-27
001 2012-01-01 ROBERT SCOTT FISHER 2013-04-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2016-01-01
001	2015-01-01
001	2014-01-01	ROBERT SCOTT FISHER
001	2013-01-01	ROBERT SCOTT FISHER	2014-02-27
001	2012-01-01	ROBERT SCOTT FISHER	2013-04-11

Plan Statistics for ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN

401k plan membership statisitcs for ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN

Measure Date Value
2016: ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2016 401k membership
Market value of plan assets 2016-12-31 1,901,745
Acturial value of plan assets 2016-12-31 1,901,745
Funding target for retired participants and beneficiaries receiving payment 2016-12-31 0
Number of terminated vested participants 2016-12-31 2
Fundng target for terminated vested participants 2016-12-31 72,548
Active participant vested funding target 2016-12-31 1,268,800
Number of active participants 2016-12-31 1
Total funding liabilities for active participants 2016-12-31 1,268,800
Total participant count 2016-12-31 3
Total funding target for all participants 2016-12-31 1,341,348
Balance at beginning of prior year after applicable adjustments 2016-12-31 0
Prefunding balance at beginning of prior year after applicable adjustments 2016-12-31 0
Carryover balanced portion elected for use to offset prior years funding requirement 2016-12-31 0
Prefunding balanced used to offset prior years funding requirement 2016-12-31 0
Amount remaining of carryover balance 2016-12-31 0
Amount remaining of prefunding balance 2016-12-31 0
Present value of excess contributions 2016-12-31 286,291
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance 2016-12-31 304,012
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance 2016-12-31 0
Reductions in caryover balances due to elections or deemed elections 2016-12-31 0
Reductions in prefunding balances due to elections or deemed elections 2016-12-31 0
Balance of carryovers at beginning of current year 2016-12-31 0
Balance of prefunding at beginning of current year 2016-12-31 0
Contributions allocated toward unpaid minimum require contributions from prior years 2016-12-31 0
Contributions made to avoid restrictions adjusted to valuation date 2016-12-31 0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date 2016-12-31 0
Unpaid minimum required contributions for all prior years 2016-12-31 0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years 2016-12-31 0
Remaining amount of unpaid minimum required contributions 2016-12-31 0
Minimum required contributions for current year target normal cost 2016-12-31 126,939
Net shortfall amortization installment of oustanding balance 2016-12-31 0
Waiver amortization installment 2016-12-31 0
Waived amount of outstanding balance 2016-12-31 0
Total funding amount beforereflecting carryover/prefunding balances 2016-12-31 0
Additional cash requirement 2016-12-31 0
Contributions allocatedtoward minimum required contributions for current year 2016-12-31 0
Unpaid minimum required contributions for current year 2016-12-31 0
Unpaid minimum required contributions for all years 2016-12-31 0
Total participants, beginning-of-year 2016-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 1
Total of all active and inactive participants 2016-01-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 3
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 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 3
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0

Measure	Date	Value
2016: ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2016 401k membership
Market value of plan assets	2016-12-31	1,901,745
Acturial value of plan assets	2016-12-31	1,901,745
Funding target for retired participants and beneficiaries receiving payment	2016-12-31	0
Number of terminated vested participants	2016-12-31	2
Fundng target for terminated vested participants	2016-12-31	72,548
Active participant vested funding target	2016-12-31	1,268,800
Number of active participants	2016-12-31	1
Total funding liabilities for active participants	2016-12-31	1,268,800
Total participant count	2016-12-31	3
Total funding target for all participants	2016-12-31	1,341,348
Balance at beginning of prior year after applicable adjustments	2016-12-31	0
Prefunding balance at beginning of prior year after applicable adjustments	2016-12-31	0
Carryover balanced portion elected for use to offset prior years funding requirement	2016-12-31	0
Prefunding balanced used to offset prior years funding requirement	2016-12-31	0
Amount remaining of carryover balance	2016-12-31	0
Amount remaining of prefunding balance	2016-12-31	0
Present value of excess contributions	2016-12-31	286,291
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance	2016-12-31	304,012
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance	2016-12-31	0
Reductions in caryover balances due to elections or deemed elections	2016-12-31	0
Reductions in prefunding balances due to elections or deemed elections	2016-12-31	0
Balance of carryovers at beginning of current year	2016-12-31	0
Balance of prefunding at beginning of current year	2016-12-31	0
Contributions allocated toward unpaid minimum require contributions from prior years	2016-12-31	0
Contributions made to avoid restrictions adjusted to valuation date	2016-12-31	0
Contributions allocated toward minimum required contributions for current year adjusted to valuation date	2016-12-31	0
Unpaid minimum required contributions for all prior years	2016-12-31	0
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years	2016-12-31	0
Remaining amount of unpaid minimum required contributions	2016-12-31	0
Minimum required contributions for current year target normal cost	2016-12-31	126,939
Net shortfall amortization installment of oustanding balance	2016-12-31	0
Waiver amortization installment	2016-12-31	0
Waived amount of outstanding balance	2016-12-31	0
Total funding amount beforereflecting carryover/prefunding balances	2016-12-31	0
Additional cash requirement	2016-12-31	0
Contributions allocatedtoward minimum required contributions for current year	2016-12-31	0
Unpaid minimum required contributions for current year	2016-12-31	0
Unpaid minimum required contributions for all years	2016-12-31	0
Total participants, beginning-of-year	2016-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	1
Total of all active and inactive participants	2016-01-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	3
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	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	3
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0

Financial Data on ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN

Measure	Date	Value
2016 : ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$21,018
Expenses. Total of all expenses incurred	2016-12-31	$111,926
Benefits paid (including direct rollovers)	2016-12-31	$111,818
Total plan assets at end of year	2016-12-31	$1,810,837
Total plan assets at beginning of year	2016-12-31	$1,901,745
Value of fidelity bond covering the plan	2016-12-31	$360,000
Total contributions received or receivable from participants	2016-12-31	$0
Expenses. Other expenses not covered elsewhere	2016-12-31	$108
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$21,018
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$-90,908
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,810,837
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,901,745
Total contributions received or receivable from employer(s)	2016-12-31	$0
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$230,703
Expenses. Total of all expenses incurred	2015-12-31	$0
Benefits paid (including direct rollovers)	2015-12-31	$0
Total plan assets at end of year	2015-12-31	$1,901,745
Total plan assets at beginning of year	2015-12-31	$1,671,042
Value of fidelity bond covering the plan	2015-12-31	$360,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-66,297
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$230,703
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,901,745
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,671,042
Total contributions received or receivable from employer(s)	2015-12-31	$297,000
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$364,688
Expenses. Total of all expenses incurred	2014-12-31	$192
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$1,671,042
Total plan assets at beginning of year	2014-12-31	$1,306,546
Value of fidelity bond covering the plan	2014-12-31	$530,000
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$-45,312
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$364,496
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,671,042
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,306,546
Total contributions received or receivable from employer(s)	2014-12-31	$410,000
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$192
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0

Form 5500 Responses for ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN

2016: ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: ROBERT SCOTT FISHER DEFINED BENEFIT PENSION PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	R. SCOTT FISHER, D.D.S., INC.
Employer identification number (EIN):	460787568
NAIC Classification:	621210
NAIC Description:	Offices of Dentists