Form 5500-Sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2011

ADVERTISEMENT

OMB Nos. 1210-0110
Form 5500-SF
Short Form Annual Return/Report of Small Employee
1210-0089
Benefit Plan
Department of the Treasury
2011
Internal Revenue Service
This form is required to be filed under sections 104 and 4065 of the Employee
Retirement Income Security Act of 1974 (ERISA), and sections 6057(b) and 6058(a) of
Department of Labor
This Form is Open to Public
the Internal Revenue Code (the Code).
Employee Benefits Security Administration
Inspection
Pension Benefit Guaranty Corporation
 Complete all entries in accordance with the instructions to the Form 5500-SF.
Part I
Annual Report Identification Information
For calendar plan year 2011 or fiscal plan year beginning
01/01/2011
and ending
12/31/2011
X
X
a single-employer plan
A
X
X
a multiple-employer plan (not multiemployer)
a one-participant plan
This return/report is for:
B
X
X
the first return/report
the final return/report
This return/report is:
X
X
an amended return/report
a short plan year return/report (less than 12 months)
X
X
X
C
Form 5558
automatic extension
DFVC program
Check box if filing under:
X
b
special extension (enter description)
Part II
Basic Plan Information
—enter all requested information
1b
1a
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
Name of plan
Three-digit
plan number
THE SCHLICHTER, BOGARD & DENTON 401(K) PLAN
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
001
001
(PN)
ABCDEFGHI ABCDEFGHI ABCDEFGHI
1c
Effective date of plan
YYYY-MM-DD
01/01/1992
2a
2b
Plan sponsor’s name and address; include room or suite number (employer, if for a single-employer plan)
Employer Identification Number
SCHLICHTER, BOGARD & DENTON
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
43-1629506
012345678
(EIN)
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
2c S
ponsor’s telephone number
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
314-621-6115
1234567890
100 SOUTH 4TH STREET, SUITE 900
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
2d
ST. LOUIS, MO 63102
Business code (see instructions)
ABCDEFGHI ABCDEFGH ABCDEFGHI ABCDEFGHI ABCDEFGHI I
123456
541110
3a
3b
Plan administrator’s name and address (if same as plan sponsor, enter “Same”)
Administrator’s EIN
43-1629506
SCHLICHTER, BOGARD & DENTON
100 SOUTH 4TH STREET, SUITE 900
ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI
012345678
ST. LOUIS, MO 63102
3c
ABCDEFGHI
Administrator’s telephone number
314-621-6115
1234567890
123456789 ABCDEFGHI ABCDEFGHI ABCDE123456789 ABCDEFGHI ABCDEFGHI A
4
If the name and/or EIN of the plan sponsor has changed since the last return/report filed for this plan, enter the
4b
012345678
EIN
name, EIN, and the plan number from the last return/report.
a
4c
Sponsor’s name
DEFGHI ABCDEFGHI ABCDEFGHI ABCDEFGHI CDEFGHI
PN
012
5a
Total number of participants at the beginning of the plan year ..................................................................................
46
5a
12345678
b
Total number of participants at the end of the plan year ............................................................................................
49
5b
12345678
c
Number of participants with account balances as of the end of the plan year (defined benefit plans do not
46
5c
12345678
complete this item) .....................................................................................................................................................
X
X
6a
X
Yes
No
Were all of the plan’s assets during the plan year invested in eligible assets? (See instructions.) ..........................................................
b
Are you claiming a waiver of the annual examination and report of an independent qualified public accountant (IQPA)
X
X
X
Yes
No
under 29 CFR 2520.104-46? (See instructions on waiver eligibility and conditions.) ................................................................................
If you answered “No” to either 6a or 6b, the plan cannot use Form 5500-SF and must instead use Form 5500.
Part III
Financial Information
7
Plan Assets and Liabilities
(a) Beginning of Year
(b) End of Year
3752086
3693491
a
-123456789012345
-123456789012345
Total plan assets ................................................................................
7a
b
0
-123456789012345
0
123456789012345
Total plan liabilities .............................................................................
7b
3693491
c
3752086
-123456789012345
-123456789012345
Net plan assets (subtract line 7b from line 7a) ...................................
7c
8
Income, Expenses, and Transfers for this Plan Year
(a) Amount
(b) Total
a
Contributions received or receivable from:
112126
-123456789012345
(1) Employers ................................................................................... 8a(1)
-123456789012345
216351
(2) Participants ................................................................................. 8a(2)
0
-123456789012345
(3) Others (including rollovers) .......................................................... 8a(3)
b
-123456789012345
-151825
Other income (loss) ............................................................................
8b
176652
c
-123456789012345
Total income (add lines 8a(1), 8a(2), 8a(3), and 8b) .........................
8c
d
Benefits paid (including direct rollovers and insurance premiums
232917
-123456789012345
to provide benefits) .............................................................................
8d
e
-123456789012345
Certain deemed and/or corrective distributions (see instructions) .....
8e
2330
f
-123456789012345
Administrative service providers (salaries, fees, commissions) .........
8f
g
-123456789012345
Other expenses ..................................................................................
8g
h
-123456789012345
235247
Total expenses (add lines 8d, 8e, 8f, and 8g) ....................................
8h
-58595
i
-123456789012345
Net income (loss) (subtract line 8h from line 8c) ................................
8i
j
Transfers to (from) the plan (see instructions) ...................................
-123456789012345
8j
For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500-SF.
Form 5500-SF (2011)
v.012611

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form 5500-sf Sample - Short Form Annual Return/report Of Small Employee Benefit Plan - 2016 Form 5500-sf Sample - Short Form Annual Return/report Of Small Employee Benefit Plan - 2016 Financial
Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2015 Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2015 Financial
Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2014 Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2014 Financial
Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2014 Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2014 Legal
Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2015 Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2015 Legal
Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2013 Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2013 Financial
Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2012 Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2012 Financial
Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2016 Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2016 Financial
Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2013 Form 5500-sf - Short Form Annual Return/report Of Small Employee Benefit Plan - 2013 Legal
Form 5500-sf Draft - Short Form Annual Return/report Of Small Employee Benefit Plan - 2017 Form 5500-sf Draft - Short Form Annual Return/report Of Small Employee Benefit Plan - 2017 Financial

Related Categories

Parent category: Financial
Download
Go
Page of 2