401k Plan data: ROGER L. GILLESPIE, DDS, INC. PROFIT SHARING PLAN plan

ROGER L. GILLESPIE, DDS, INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	ROGER L. GILLESPIE, DDS, INC. PROFIT SHARING PLAN
Plan identification number	003

ROGER L. GILLESPIE, DDS, INC. 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.
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.
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.

401k Sponsoring company profile

ROGER L GILLESPIE, DDS, INC has sponsored the creation of one or more 401k plans.

Company Name: ROGER L GILLESPIE, DDS, INC

Employer identification number (EIN): 952621011

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROGER L. GILLESPIE, DDS, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2019-01-01 ROGER L GILLESPIE 2020-07-01
003 2018-01-01 ROGER L GILLESPIE 2019-07-22
003 2017-01-01 ROGER L GILLESPIE 2018-07-26
003 2016-01-01 ROGER L GILLESPIE 2017-07-25
003 2015-01-01 ROGER L GILLESPIE 2016-07-26
003 2014-01-01 MISFIT1026 2015-06-23 MISFIT1026 2015-06-23
003 2013-01-01 MISFIT1026 2014-05-22 MISFIT1026 2014-05-22
003 2012-01-01 ROGER L. GILLESPIE, D.D.S., INC. 2013-09-05 ROGER L. GILLESPIE, D.D.S., INC. 2013-09-05
003 2011-01-01 ROGER L. GILLESPIE, D.D.S., INC. 2012-06-26 ROGER L. GILLESPIE, D.D.S., INC. 2012-06-26
003 2009-01-01 ROGER L. GILLESPIE, D.D.S. ROGER L. GILLESPIE, D.D.S. 2010-06-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2019-01-01	ROGER L GILLESPIE	2020-07-01
003	2018-01-01	ROGER L GILLESPIE	2019-07-22
003	2017-01-01	ROGER L GILLESPIE	2018-07-26
003	2016-01-01	ROGER L GILLESPIE	2017-07-25
003	2015-01-01	ROGER L GILLESPIE	2016-07-26
003	2014-01-01	MISFIT1026	2015-06-23	MISFIT1026	2015-06-23
003	2013-01-01	MISFIT1026	2014-05-22	MISFIT1026	2014-05-22
003	2012-01-01	ROGER L. GILLESPIE, D.D.S., INC.	2013-09-05	ROGER L. GILLESPIE, D.D.S., INC.	2013-09-05
003	2011-01-01	ROGER L. GILLESPIE, D.D.S., INC.	2012-06-26	ROGER L. GILLESPIE, D.D.S., INC.	2012-06-26
003	2009-01-01	ROGER L. GILLESPIE, D.D.S.		ROGER L. GILLESPIE, D.D.S.	2010-06-09

Plan Statistics for ROGER L. GILLESPIE, DDS, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for ROGER L. GILLESPIE, DDS, INC. PROFIT SHARING PLAN

Measure Date Value
2009: ROGER L. GILLESPIE, DDS, INC. 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 5
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 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 5
Number of participants with account balances 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
2009: ROGER L. GILLESPIE, DDS, INC. 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	5
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	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	5
Number of participants with account balances	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 ROGER L. GILLESPIE, DDS, INC. PROFIT SHARING PLAN

Measure	Date	Value
2011 : ROGER L. GILLESPIE, DDS, INC. PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$-46,186
Expenses. Total of all expenses incurred	2011-12-31	$72
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$646,575
Total plan assets at beginning of year	2011-12-31	$692,833
Value of fidelity bond covering the plan	2011-12-31	$0
Assets. Value of tangible personal property	2011-12-31	$0
Total contributions received or receivable from participants	2011-12-31	$1,100
Assets. Value of loans (other than to participants)	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$72
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-54,788
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-46,258
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$646,575
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$692,833
Assets. Value of participant loans	2011-12-31	$9,014
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2011-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2011-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$0
Assets. Value of real-estate (other than employer real property)	2011-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2011-12-31	$0
Assets. Value of employer securities	2011-12-31	$0
Assets. Value of employer real property	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$7,502
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
2010 : ROGER L. GILLESPIE, DDS, INC. PROFIT SHARING 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	$22,968
Expenses. Total of all expenses incurred	2010-12-31	$90,069
Benefits paid (including direct rollovers)	2010-12-31	$90,000
Total plan assets at end of year	2010-12-31	$692,833
Total plan assets at beginning of year	2010-12-31	$759,934
Value of fidelity bond covering the plan	2010-12-31	$0
Assets. Value of tangible personal property	2010-12-31	$0
Total contributions received or receivable from participants	2010-12-31	$1,200
Assets. Value of loans (other than to participants)	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$69
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$17,362
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$-67,101
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$692,833
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$759,934
Assets. Value of participant loans	2010-12-31	$69,363
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2010-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2010-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$0
Assets. Value of real-estate (other than employer real property)	2010-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2010-12-31	$0
Assets. Value of employer securities	2010-12-31	$0
Assets. Value of employer real property	2010-12-31	$0
Total contributions received or receivable from employer(s)	2010-12-31	$4,406
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
2009 : ROGER L. GILLESPIE, DDS, INC. 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
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for ROGER L. GILLESPIE, DDS, INC. PROFIT SHARING PLAN

2009: ROGER L. GILLESPIE, DDS, INC. 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	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

952621011D3

Policy instance

Insurance contract or identification number	952621011D3
Number of Individuals Covered	6
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	ROGER L GILLESPIE, DDS, INC
Employer identification number (EIN):	952621011
NAIC Classification:	621210
NAIC Description:	Offices of Dentists