401k Plan data: A. R. HENDRICKSEN, DDS, INC. 401K PLAN plan

A. R. HENDRICKSEN, DDS, INC. 401K PLAN 401k Plan overview

Plan Name	A. R. HENDRICKSEN, DDS, INC. 401K PLAN
Plan identification number	003

A. R. HENDRICKSEN, DDS, INC. 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
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

A. R. HENDRICKSEN, DDS, INC. has sponsored the creation of one or more 401k plans.

Company Name: A. R. HENDRICKSEN, DDS, INC.

Employer identification number (EIN): 541202429

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan A. R. HENDRICKSEN, DDS, INC. 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2019-01-01 A. R. HENDRICKSEN 2020-07-07
003 2018-01-01 A. R. HENDRICKSEN 2019-04-02
003 2017-01-01 A. R. HENDRICKSEN 2018-04-25
003 2016-01-01 A. R. HENDRICKSEN 2017-07-09
003 2015-01-01 A. R. HENDRICKSEN 2016-06-13
003 2014-01-01 A. R. HENDRICKSEN 2015-06-11
003 2013-01-01 A. R. HENDRICKSEN
003 2012-01-01 A. R. HENDRICKSEN
003 2011-01-01 A.R. HENDRICKSEN
003 2009-01-01 A.R. HENDRICKSEN
003 2009-01-01 A.R. HENDRICKSEN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
003	2019-01-01	A. R. HENDRICKSEN	2020-07-07
003	2018-01-01	A. R. HENDRICKSEN	2019-04-02
003	2017-01-01	A. R. HENDRICKSEN	2018-04-25
003	2016-01-01	A. R. HENDRICKSEN	2017-07-09
003	2015-01-01	A. R. HENDRICKSEN	2016-06-13
003	2014-01-01	A. R. HENDRICKSEN	2015-06-11
003	2013-01-01	A. R. HENDRICKSEN
003	2012-01-01	A. R. HENDRICKSEN
003	2011-01-01	A.R. HENDRICKSEN
003	2009-01-01	A.R. HENDRICKSEN
003	2009-01-01	A.R. HENDRICKSEN

Plan Statistics for A. R. HENDRICKSEN, DDS, INC. 401K PLAN

401k plan membership statisitcs for A. R. HENDRICKSEN, DDS, INC. 401K PLAN

Measure Date Value
2013: A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 8
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 1
Total of all active and inactive participants 2013-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 7
Number of participants with account balances 2013-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 7
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 1
Total of all active and inactive participants 2012-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 8
Number of participants with account balances 2012-01-01 8
2011: A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 7
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 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 7
Number of participants with account balances 2011-01-01 7
2009: A. R. HENDRICKSEN, DDS, INC. 401K 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 0
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 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 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
2013: A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	8
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	1
Total of all active and inactive participants	2013-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	7
Number of participants with account balances	2013-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	7
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	1
Total of all active and inactive participants	2012-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	8
Number of participants with account balances	2012-01-01	8
2011: A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	7
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	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	7
Number of participants with account balances	2011-01-01	7
2009: A. R. HENDRICKSEN, DDS, INC. 401K 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	0
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	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	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 A. R. HENDRICKSEN, DDS, INC. 401K PLAN

Measure	Date	Value
2013 : A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$177,796
Expenses. Total of all expenses incurred	2013-12-31	$3,438
Benefits paid (including direct rollovers)	2013-12-31	$3,438
Total plan assets at end of year	2013-12-31	$768,905
Total plan assets at beginning of year	2013-12-31	$594,547
Value of fidelity bond covering the plan	2013-12-31	$80,000
Total contributions received or receivable from participants	2013-12-31	$53,630
Other income received	2013-12-31	$47,355
Net income (gross income less expenses)	2013-12-31	$174,358
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$768,905
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$594,547
Total contributions received or receivable from employer(s)	2013-12-31	$76,811
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$134,336
Total plan assets at end of year	2012-12-31	$594,547
Total plan assets at beginning of year	2012-12-31	$460,211
Total contributions received or receivable from participants	2012-12-31	$54,125
Other income received	2012-12-31	$52,406
Net income (gross income less expenses)	2012-12-31	$134,336
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$594,547
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$460,211
Total contributions received or receivable from employer(s)	2012-12-31	$27,805
2011 : A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$116,684
Expenses. Total of all expenses incurred	2011-12-31	$3,584
Benefits paid (including direct rollovers)	2011-12-31	$3,584
Total plan assets at end of year	2011-12-31	$460,211
Total plan assets at beginning of year	2011-12-31	$347,111
Total contributions received or receivable from participants	2011-12-31	$53,640
Other income received	2011-12-31	$5,950
Net income (gross income less expenses)	2011-12-31	$113,100
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$460,211
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$347,111
Total contributions received or receivable from employer(s)	2011-12-31	$57,094
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$144,818
Expenses. Total of all expenses incurred	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$347,111
Total plan assets at beginning of year	2010-12-31	$202,293
Total contributions received or receivable from participants	2010-12-31	$54,926
Other income received	2010-12-31	$33,329
Net income (gross income less expenses)	2010-12-31	$144,818
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$347,111
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$202,293
Total contributions received or receivable from employer(s)	2010-12-31	$56,563
2009 : A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for A. R. HENDRICKSEN, DDS, INC. 401K PLAN

2013: A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: A. R. HENDRICKSEN, DDS, INC. 401K PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: A. R. HENDRICKSEN, DDS, INC. 401K 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: A. R. HENDRICKSEN, DDS, INC. 401K 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:	A. R. HENDRICKSEN, DDS, INC.
Employer identification number (EIN):	541202429
NAIC Classification:	621210
NAIC Description:	Offices of Dentists