401k Plan data: DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN plan

DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 401k Plan overview

Plan Name	DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN
Plan identification number	001

DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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.
Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

DAVID JENSEN, DDS, PA JENSEN has sponsored the creation of one or more 401k plans.

Company Name: DAVID JENSEN, DDS, PA JENSEN

Employer identification number (EIN): 593465399

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01 DAVID R JENSEN 2018-07-11
001 2016-01-01 DAVID JENSEN 2017-09-01
001 2015-01-01 DAVID JENSEN 2016-09-27
001 2014-01-01 DAVID JENSEN DAVID JENSEN 2015-07-31
001 2013-01-01 DAVID JENSEN DAVID JENSEN 2014-09-04
001 2012-01-01 STEVE BARNIER STEVE BARNIER 2013-07-30
001 2011-01-01 DAVID JENSEN DAVID JENSEN 2012-08-23
001 2009-01-01 DAVID JENSEN 2012-08-23 DAVID JENSEN 2012-08-23
001 2009-01-01 DAVID JENSEN 2012-08-14 DAVID JENSEN 2012-08-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2017-01-01	DAVID R JENSEN	2018-07-11
001	2016-01-01	DAVID JENSEN	2017-09-01
001	2015-01-01	DAVID JENSEN	2016-09-27
001	2014-01-01	DAVID JENSEN		DAVID JENSEN	2015-07-31
001	2013-01-01	DAVID JENSEN		DAVID JENSEN	2014-09-04
001	2012-01-01	STEVE BARNIER		STEVE BARNIER	2013-07-30
001	2011-01-01	DAVID JENSEN		DAVID JENSEN	2012-08-23
001	2009-01-01	DAVID JENSEN	2012-08-23	DAVID JENSEN	2012-08-23
001	2009-01-01	DAVID JENSEN	2012-08-14	DAVID JENSEN	2012-08-14

Plan Statistics for DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN

401k plan membership statisitcs for DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN

Measure Date Value
2014: DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 7
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 0
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: DAVID R. JENSEN, DDA, PA PROFIT SHARING 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 0
Total of all active and inactive participants 2012-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 7
Number of participants with account balances 2012-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: DAVID R. JENSEN, DDA, PA PROFIT SHARING 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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: DAVID R. JENSEN, DDA, PA PROFIT SHARING 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 8
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 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 8
Number of participants with account balances 2009-01-01 8

Measure	Date	Value
2014: DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	7
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	0
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: DAVID R. JENSEN, DDA, PA PROFIT SHARING 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	0
Total of all active and inactive participants	2012-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	7
Number of participants with account balances	2012-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: DAVID R. JENSEN, DDA, PA PROFIT SHARING 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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: DAVID R. JENSEN, DDA, PA PROFIT SHARING 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	8
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	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	8
Number of participants with account balances	2009-01-01	8

Financial Data on DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN

Measure	Date	Value
2014 : DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$40,322
Expenses. Total of all expenses incurred	2014-12-31	$662
Total plan assets at end of year	2014-12-31	$469,238
Total plan assets at beginning of year	2014-12-31	$429,578
Other income received	2014-12-31	$40,322
Net income (gross income less expenses)	2014-12-31	$39,660
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$469,238
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$429,578
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$662
2013 : DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$99,588
Expenses. Total of all expenses incurred	2013-12-31	$539
Total plan assets at end of year	2013-12-31	$429,578
Total plan assets at beginning of year	2013-12-31	$330,529
Other income received	2013-12-31	$74,588
Net income (gross income less expenses)	2013-12-31	$99,049
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$429,578
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$330,529
Total contributions received or receivable from employer(s)	2013-12-31	$25,000
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$539
2012 : DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$48,234
Expenses. Total of all expenses incurred	2012-12-31	$444
Total plan assets at end of year	2012-12-31	$330,529
Total plan assets at beginning of year	2012-12-31	$282,739
Other income received	2012-12-31	$32,234
Net income (gross income less expenses)	2012-12-31	$47,790
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$330,529
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$282,739
Total contributions received or receivable from employer(s)	2012-12-31	$16,000
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$444
2011 : DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$23,145
Expenses. Total of all expenses incurred	2011-12-31	$397
Total plan assets at end of year	2011-12-31	$282,739
Total plan assets at beginning of year	2011-12-31	$259,991
Other income received	2011-12-31	$3,145
Net income (gross income less expenses)	2011-12-31	$22,748
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$282,739
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$259,991
Total contributions received or receivable from employer(s)	2011-12-31	$20,000
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$397
2010 : DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$25,982
Expenses. Total of all expenses incurred	2010-12-31	$424
Total plan assets at end of year	2010-12-31	$259,991
Total plan assets at beginning of year	2010-12-31	$234,433
Other income received	2010-12-31	$25,982
Net income (gross income less expenses)	2010-12-31	$25,558
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$259,991
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$234,433
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$424

Form 5500 Responses for DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN

2014: DAVID R. JENSEN, DDA, PA PROFIT SHARING 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
2013: DAVID R. JENSEN, DDA, PA PROFIT SHARING 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: DAVID R. JENSEN, DDA, PA PROFIT SHARING 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: DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: DAVID R. JENSEN, DDA, PA PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	DAVID JENSEN, DDS, PA JENSEN
Employer identification number (EIN):	593465399
NAIC Classification:	621210
NAIC Description:	Offices of Dentists