401k Plan data: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN plan

GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN
Plan identification number	001

GABRIEL A. CHAMBLIN, D.M.D. 401(K) 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
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.
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.
Participant-directed brokerage accounts provided as an investment option under the plan.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan covering Self-Employed individuals.
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

GABRIEL A. CHAMBLIN, D.M.D., LLC has sponsored the creation of one or more 401k plans.

Company Name: GABRIEL A. CHAMBLIN, D.M.D., LLC

Employer identification number (EIN): 630931801

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING 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 GABRIEL A. CHAMBLIN, DMD 2019-05-01
001 2017-01-01 GABRIEL A. CHAMBLIN, DMD 2018-10-11
001 2016-01-01 GABRIEL A. CHAMBLIN, DMD 2017-04-06
001 2015-01-01 GABRIEL A. CHAMBLIN, DMD 2016-08-31
001 2014-01-01 GABRIEL A. CHAMBLIN, D.M.D. 2015-06-24
001 2013-01-01 GABRIEL A. CHAMBLIN, D.M.D. 2014-07-15
001 2012-01-01 GABRIEL A. CHAMBLIN, D.M.D. 2013-07-26
001 2011-01-01 GABRIEL A. CHAMBLIN, D.M.D. 2012-10-15
001 2010-01-01 GABRIEL A. CHAMBLIN, D.M.D. 2011-09-13 GABRIEL A. CHAMBLIN, D.M.D. 2011-09-13

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	GABRIEL A. CHAMBLIN, DMD	2019-05-01
001	2017-01-01	GABRIEL A. CHAMBLIN, DMD	2018-10-11
001	2016-01-01	GABRIEL A. CHAMBLIN, DMD	2017-04-06
001	2015-01-01	GABRIEL A. CHAMBLIN, DMD	2016-08-31
001	2014-01-01	GABRIEL A. CHAMBLIN, D.M.D.	2015-06-24
001	2013-01-01	GABRIEL A. CHAMBLIN, D.M.D.	2014-07-15
001	2012-01-01	GABRIEL A. CHAMBLIN, D.M.D.	2013-07-26
001	2011-01-01	GABRIEL A. CHAMBLIN, D.M.D.	2012-10-15
001	2010-01-01	GABRIEL A. CHAMBLIN, D.M.D.	2011-09-13	GABRIEL A. CHAMBLIN, D.M.D.	2011-09-13

Plan Statistics for GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN

Measure Date Value
2022: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1
Number of retired or separated participants receiving benefits 2022-01-01 6
Total of all active and inactive participants 2022-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 7
Number of participants with account balances 2022-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 8
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 1
Total of all active and inactive participants 2021-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 9
Number of participants with account balances 2021-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 1
2020: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 7
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 1
Total of all active and inactive participants 2020-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 8
Number of participants with account balances 2020-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 6
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 6
Number of participants with account balances 2019-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0

Measure	Date	Value
2022: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1
Number of retired or separated participants receiving benefits	2022-01-01	6
Total of all active and inactive participants	2022-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	7
Number of participants with account balances	2022-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	8
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	1
Total of all active and inactive participants	2021-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	9
Number of participants with account balances	2021-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	1
2020: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	7
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	1
Total of all active and inactive participants	2020-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	8
Number of participants with account balances	2020-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	6
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	6
Number of participants with account balances	2019-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0

Financial Data on GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2022 : GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2022 401k financial data
Transfers to/from the plan	2022-12-31	$0
Total plan liabilities at end of year	2022-12-31	$0
Total plan liabilities at beginning of year	2022-12-31	$0
Total income from all sources	2022-12-31	$-74,067
Expenses. Total of all expenses incurred	2022-12-31	$2,485,321
Benefits paid (including direct rollovers)	2022-12-31	$2,464,847
Total plan assets at end of year	2022-12-31	$146,543
Total plan assets at beginning of year	2022-12-31	$2,705,931
Value of fidelity bond covering the plan	2022-12-31	$250,000
Total contributions received or receivable from participants	2022-12-31	$55,908
Expenses. Other expenses not covered elsewhere	2022-12-31	$0
Contributions received from other sources (not participants or employers)	2022-12-31	$0
Other income received	2022-12-31	$-180,379
Noncash contributions received	2022-12-31	$0
Net income (gross income less expenses)	2022-12-31	$-2,559,388
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$146,543
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$2,705,931
Total contributions received or receivable from employer(s)	2022-12-31	$50,404
Value of certain deemed distributions of participant loans	2022-12-31	$0
Value of corrective distributions	2022-12-31	$307
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$20,167
2021 : GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2021 401k financial data
Transfers to/from the plan	2021-12-31	$0
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$357,808
Expenses. Total of all expenses incurred	2021-12-31	$28,085
Benefits paid (including direct rollovers)	2021-12-31	$7,548
Total plan assets at end of year	2021-12-31	$2,705,931
Total plan assets at beginning of year	2021-12-31	$2,376,208
Value of fidelity bond covering the plan	2021-12-31	$200,000
Assets. Value of tangible personal property	2021-12-31	$0
Total contributions received or receivable from participants	2021-12-31	$44,047
Assets. Value of loans (other than to participants)	2021-12-31	$0
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$281,780
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$329,723
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$2,705,931
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$2,376,208
Assets. Value of participant loans	2021-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2021-12-31	$0
Assets. Value of real-estate (other than employer real property)	2021-12-31	$0
Assets. Value of employer securities	2021-12-31	$0
Assets. Value of employer real property	2021-12-31	$0
Total contributions received or receivable from employer(s)	2021-12-31	$31,981
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$20,537
2020 : GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2020 401k financial data
Transfers to/from the plan	2020-12-31	$0
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$315,843
Expenses. Total of all expenses incurred	2020-12-31	$9,149
Benefits paid (including direct rollovers)	2020-12-31	$290
Total plan assets at end of year	2020-12-31	$2,376,208
Total plan assets at beginning of year	2020-12-31	$2,069,514
Value of fidelity bond covering the plan	2020-12-31	$200,000
Total contributions received or receivable from participants	2020-12-31	$31,187
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$245,889
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$306,694
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$2,376,208
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$2,069,514
Total contributions received or receivable from employer(s)	2020-12-31	$38,767
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$8,859
2019 : GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$229,004
Expenses. Total of all expenses incurred	2019-12-31	$17,279
Benefits paid (including direct rollovers)	2019-12-31	$16,389
Total plan assets at end of year	2019-12-31	$2,069,514
Total plan assets at beginning of year	2019-12-31	$1,857,789
Value of fidelity bond covering the plan	2019-12-31	$200,000
Total contributions received or receivable from participants	2019-12-31	$71,570
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$157,434
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$211,725
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$2,069,514
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$1,857,789
Total contributions received or receivable from employer(s)	2019-12-31	$0
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$890

Form 5500 Responses for GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN

2022: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	This submission is the final filing	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: GABRIEL A. CHAMBLIN, D.M.D. 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	GABRIEL A. CHAMBLIN, D.M.D., LLC
Employer identification number (EIN):	630931801
NAIC Classification:	621210
NAIC Description:	Offices of Dentists