401k Plan data: ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN plan

ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN 401k Plan overview

Plan Name	ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN
Plan identification number	003

ROY S. SHELBURNE, DDS, LTD PROFIT SHARING 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
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

ROY S. SHELBURNE, DDS, LTD has sponsored the creation of one or more 401k plans.

Company Name: ROY S. SHELBURNE, DDS, LTD

Employer identification number (EIN): 541971923

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2017-01-01 ROY S. SHELBURNE 2018-04-25
003 2016-01-01 ROY S. SHELBURNE 2017-03-01
003 2015-01-01 ROY S. SHELBURNE 2016-02-24
003 2014-01-01 ROY S. SHELBURNE 2015-02-10
003 2013-01-01 ROY S. SHELBURNE
003 2012-01-01 ROY S. SHELBURNE
003 2011-01-01 ROY S. SHELBURNE
003 2009-01-01 DEBORAH SHELBURNE DEBORAH SHELBURNE 2010-05-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2017-01-01	ROY S. SHELBURNE	2018-04-25
003	2016-01-01	ROY S. SHELBURNE	2017-03-01
003	2015-01-01	ROY S. SHELBURNE	2016-02-24
003	2014-01-01	ROY S. SHELBURNE	2015-02-10
003	2013-01-01	ROY S. SHELBURNE
003	2012-01-01	ROY S. SHELBURNE
003	2011-01-01	ROY S. SHELBURNE
003	2009-01-01	DEBORAH SHELBURNE		DEBORAH SHELBURNE	2010-05-17

Plan Statistics for ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN

401k plan membership statisitcs for ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN

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

Financial Data on ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN

Measure	Date	Value
2013 : ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$241,950
Total plan assets at end of year	2013-12-31	$1,057,315
Total plan assets at beginning of year	2013-12-31	$815,365
Other income received	2013-12-31	$241,950
Net income (gross income less expenses)	2013-12-31	$241,950
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,057,315
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$815,365
Assets. Value of participant loans	2013-12-31	$23,344
2012 : ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$66,383
Total plan assets at end of year	2012-12-31	$815,365
Total plan assets at beginning of year	2012-12-31	$748,982
Other income received	2012-12-31	$66,383
Net income (gross income less expenses)	2012-12-31	$66,383
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$815,365
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$748,982
2011 : ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$-110,747
Expenses. Total of all expenses incurred	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$748,982
Total plan assets at beginning of year	2011-12-31	$859,729
Other income received	2011-12-31	$-110,747
Net income (gross income less expenses)	2011-12-31	$-110,747
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$748,982
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$859,729
2010 : ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$154,561
Expenses. Total of all expenses incurred	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$859,729
Total plan assets at beginning of year	2010-12-31	$705,168
Other income received	2010-12-31	$154,561
Net income (gross income less expenses)	2010-12-31	$154,561
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$859,729
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$705,168
2009 : ROY S. SHELBURNE, DDS, LTD PROFIT SHARING 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 ROY S. SHELBURNE, DDS, LTD PROFIT SHARING PLAN

2013: ROY S. SHELBURNE, DDS, LTD 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: ROY S. SHELBURNE, DDS, LTD 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: ROY S. SHELBURNE, DDS, LTD PROFIT SHARING 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: ROY S. SHELBURNE, DDS, LTD PROFIT SHARING 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:	ROY S. SHELBURNE, DDS, LTD
Employer identification number (EIN):	541971923
NAIC Classification:	621210
NAIC Description:	Offices of Dentists