401k Plan data: DELTA DENTAL CASH OR DEFERRED INCOME PLAN plan

DELTA DENTAL CASH OR DEFERRED INCOME PLAN 401k Plan overview

Plan Name	DELTA DENTAL CASH OR DEFERRED INCOME PLAN
Plan identification number	001

DELTA DENTAL CASH OR DEFERRED INCOME 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.
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.
Plan not intended to be qualified - A plan not intended to be qualified under Code sections 401, 403, or 408.

401k Sponsoring company profile

DELTA DENTAL OF PUERTO RIRCO, INC. has sponsored the creation of one or more 401k plans.

Company Name: DELTA DENTAL OF PUERTO RIRCO, INC.

Employer identification number (EIN): 680652604

NAIC Classification: 524150

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DELTA DENTAL CASH OR DEFERRED INCOME PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01
001 2016-01-01 JEAN KARLO ROCAFORT 2017-07-04
001 2015-01-01 JEAN KARLO ROCAFORT 2016-07-28
001 2014-01-01 RAFAEL BURGOS 2015-07-30
001 2013-01-01
001 2012-01-01 MARIANNE ORTIZ RIVERA RAFAEL BURGOS SANCHEZ 2013-04-16
001 2011-01-01 MARIANNE ORTIZ RIVERA RAFAEL BURGOS SANCHEZ 2012-05-15
001 2010-01-01 MARIANNE ORTIZ RIVERA RAFAEL BURGOS SANCHEZ 2011-10-06
001 2009-01-01 MARIANNE ORTIZ RIVERA RAFAEL BURGOS SANCHEZ 2010-05-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2023-01-01
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01
001	2016-01-01	JEAN KARLO ROCAFORT	2017-07-04
001	2015-01-01	JEAN KARLO ROCAFORT	2016-07-28
001	2014-01-01	RAFAEL BURGOS	2015-07-30
001	2013-01-01
001	2012-01-01	MARIANNE ORTIZ RIVERA		RAFAEL BURGOS SANCHEZ	2013-04-16
001	2011-01-01	MARIANNE ORTIZ RIVERA		RAFAEL BURGOS SANCHEZ	2012-05-15
001	2010-01-01	MARIANNE ORTIZ RIVERA		RAFAEL BURGOS SANCHEZ	2011-10-06
001	2009-01-01	MARIANNE ORTIZ RIVERA		RAFAEL BURGOS SANCHEZ	2010-05-24

Plan Statistics for DELTA DENTAL CASH OR DEFERRED INCOME PLAN

401k plan membership statisitcs for DELTA DENTAL CASH OR DEFERRED INCOME PLAN

Measure Date Value
2012: DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 47
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 41
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 41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 41
Number of participants with account balances 2012-01-01 41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 47
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 47
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 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 47
Number of participants with account balances 2011-01-01 47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 5
2010: DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 30
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 47
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 47
Number of participants with account balances 2010-01-01 41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 4
2009: DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 27
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 30
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 30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 30
Number of participants with account balances 2009-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2012: DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	47
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	41
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	41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	41
Number of participants with account balances	2012-01-01	41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	47
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	47
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	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	47
Number of participants with account balances	2011-01-01	47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	5
2010: DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	30
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	47
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	47
Number of participants with account balances	2010-01-01	41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	4
2009: DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	30
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	30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	30
Number of participants with account balances	2009-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on DELTA DENTAL CASH OR DEFERRED INCOME PLAN

Measure	Date	Value
2012 : DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$125,047
Expenses. Total of all expenses incurred	2012-12-31	$5,754
Benefits paid (including direct rollovers)	2012-12-31	$5,754
Total plan assets at end of year	2012-12-31	$872,619
Total plan assets at beginning of year	2012-12-31	$753,326
Value of fidelity bond covering the plan	2012-12-31	$500,000
Total contributions received or receivable from participants	2012-12-31	$65,089
Other income received	2012-12-31	$27,413
Net income (gross income less expenses)	2012-12-31	$119,293
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$872,619
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$753,326
Total contributions received or receivable from employer(s)	2012-12-31	$32,545
2011 : DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2011 401k financial data
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$39,290
Expenses. Total of all expenses incurred	2011-12-31	$7,808
Benefits paid (including direct rollovers)	2011-12-31	$7,808
Total plan assets at end of year	2011-12-31	$753,326
Total plan assets at beginning of year	2011-12-31	$721,844
Value of fidelity bond covering the plan	2011-12-31	$500,000
Total contributions received or receivable from participants	2011-12-31	$47,065
Noncash contributions received	2011-12-31	$-31,307
Net income (gross income less expenses)	2011-12-31	$31,482
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$753,326
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$721,844
Total contributions received or receivable from employer(s)	2011-12-31	$23,532
2010 : DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$97,551
Expenses. Total of all expenses incurred	2010-12-31	$11,420
Benefits paid (including direct rollovers)	2010-12-31	$11,420
Total plan assets at end of year	2010-12-31	$721,844
Total plan assets at beginning of year	2010-12-31	$635,713
Value of fidelity bond covering the plan	2010-12-31	$500,000
Total contributions received or receivable from participants	2010-12-31	$42,158
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$34,314
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$86,131
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$721,844
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$635,713
Total contributions received or receivable from employer(s)	2010-12-31	$21,079
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0

Form 5500 Responses for DELTA DENTAL CASH OR DEFERRED INCOME PLAN

2012: DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: DELTA DENTAL CASH OR DEFERRED INCOME 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
2010: DELTA DENTAL CASH OR DEFERRED INCOME PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: DELTA DENTAL CASH OR DEFERRED INCOME 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:	DELTA DENTAL OF PUERTO RIRCO, INC.
Employer identification number (EIN):	680652604
NAIC Classification:	524150