Personal Financial Statement
For your eyes only · Fill it honestly · Complete on the same date every year
| Assets: Everything You Own (Enter current market value) | |
| Description | Current Value ($) |
| Real Estate | |
| Primary residence - current market value | |
| Other real estate - current market value | |
| Real estate total | - |
| Practice & Business | |
| Practice - estimated fair market value | |
| Equipment (chairs, CBCT, laser, technology) | |
| Practice & business total | - |
| Cash & Investments | |
| Checking and savings accounts | |
| Cash on hand | |
| Stocks, bonds, mutual funds - current market value | |
| Cryptocurrency - current market value | |
| Other investments | |
| Cash & investments total | - |
| Retirement Accounts | |
| 401(k) / 403(b) - current balance | |
| IRA / Roth IRA - current balance | |
| HSA balance (Health Savings Account - balances roll over and can grow tax-free when used for qualified medical expenses) | |
| Other retirement accounts | |
| Retirement accounts total | - |
| Vehicles & Personal Property | |
| Vehicle 1 - current market value | |
| Vehicle 2 - current market value | |
| Life insurance - cash surrender value | |
| Jewelry, art, and collectibles | |
| Furniture and household goods (conservative estimate) | |
| Other personal property | |
| Vehicles & personal property total | - |
| Total Assets | - |
| Liabilities: Everything You Owe | Monthly Pmt ($) | Total Owed ($) |
| Description | Monthly Pmt | Total Owed |
| Primary mortgage | ||
| Second mortgage or home equity loan (HELOC) | ||
| Practice / business loan | ||
| Equipment financing | ||
| Student loans | ||
| Vehicle loans | ||
| Credit card balances | ||
| Taxes owed (current year estimate) | ||
| Personal loans or lines of credit | ||
| Any other liabilities | ||
| Total Liabilities | - | - |
| Net Worth Total Assets minus Total Liabilities | |
| Total Assets | - |
| Total Liabilities | - |
| Net Worth | - |
Positive = you own more than you owe · Negative = you owe more than you own
| Annual Income | |
| Description | Annual Amount ($) |
| Gross income from practice (before tax) | |
| Associate or other dental income | |
| Rental income | |
| Investment and dividend income | |
| Spouse or partner income | |
| Any other income | |
| Total gross annual income | - |
| Total annual taxes paid | |
| Net Annual Income (after tax) | - |
| Monthly Obligations | Monthly ($) | Annual ($) |
| Description | Monthly | Annual |
| Mortgage or rent | - | |
| Practice loan payment | - | |
| Student loan payment | - | |
| Vehicle loan payment(s) | - | |
| Credit card minimum payments | - | |
| Insurance (life, disability, health, malpractice) | - | |
| Other fixed monthly obligations | - | |
| Total Monthly Obligations | - | - |
| Debt-to-income ratio: Divide your total monthly obligations by your gross monthly income. The lower the number, the stronger your financial position. | - | |
| Notes Observations, concerns, and goals for this year |
Save a copy each year to track your progress over time.