401k Plan data: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN plan

ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 401k Plan overview

Plan Name	ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN
Plan identification number	001

ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
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

ROBERT B. CHAMBLISS, M.D. has sponsored the creation of one or more 401k plans.

Company Name: ROBERT B. CHAMBLISS, M.D.

Employer identification number (EIN): 610621904

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01 CHARLES DURKOT, E.A. 2019-05-09 CHARLES DURKOT, E.A. 2019-05-09
001 2018-01-01 CHARLES DURKOT, E.A. 2019-04-29 CHARLES DURKOT, E.A. 2019-04-29
001 2017-01-01 CHARLES DURKOT, E.A. 2018-10-09 CHARLES DURKOT, E.A. 2018-10-09
001 2016-01-01 CHARLES DURKOT, E.A. 2017-08-31 CHARLES DURKOT, E.A. 2017-08-31
001 2015-01-01 CHARLES DURKOT, E.A. 2016-10-17 CHARLES DURKOT, E.A. 2016-10-17
001 2014-01-01 CHARLES DURKOT, E.A. 2015-10-13 CHARLES DURKOT, E.A. 2015-10-13
001 2013-01-01 PAMELA L BOBERSKY PAMELA L BOBERSKY 2014-10-13
001 2012-01-01 PAMELA L BOBERSKY PAMELA L BOBERSKY 2013-10-12
001 2011-01-01 ROBERT B. CHAMBLISS
001 2010-01-01 ROBERT B. CHAMBLISS
001 2009-01-01 THOMAS M. KOCH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2019-01-01	CHARLES DURKOT, E.A.	2019-05-09	CHARLES DURKOT, E.A.	2019-05-09
001	2018-01-01	CHARLES DURKOT, E.A.	2019-04-29	CHARLES DURKOT, E.A.	2019-04-29
001	2017-01-01	CHARLES DURKOT, E.A.	2018-10-09	CHARLES DURKOT, E.A.	2018-10-09
001	2016-01-01	CHARLES DURKOT, E.A.	2017-08-31	CHARLES DURKOT, E.A.	2017-08-31
001	2015-01-01	CHARLES DURKOT, E.A.	2016-10-17	CHARLES DURKOT, E.A.	2016-10-17
001	2014-01-01	CHARLES DURKOT, E.A.	2015-10-13	CHARLES DURKOT, E.A.	2015-10-13
001	2013-01-01	PAMELA L BOBERSKY		PAMELA L BOBERSKY	2014-10-13
001	2012-01-01	PAMELA L BOBERSKY		PAMELA L BOBERSKY	2013-10-12
001	2011-01-01	ROBERT B. CHAMBLISS
001	2010-01-01	ROBERT B. CHAMBLISS
001	2009-01-01	THOMAS M. KOCH

Plan Statistics for ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN

401k plan membership statisitcs for ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN

Measure Date Value
2013: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
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 10
Total of all active and inactive participants 2013-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 10
Number of participants with account balances 2013-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 11
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 10
Total of all active and inactive participants 2012-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 10
Number of participants with account balances 2012-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 3
Number of retired or separated participants receiving benefits 2011-01-01 1
Number of other retired or separated participants entitled to future benefits 2011-01-01 7
Total of all active and inactive participants 2011-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 11
Number of participants with account balances 2011-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 1
2010: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 11
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 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 11
Number of participants with account balances 2010-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 11
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 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 11
Number of participants with account balances 2009-01-01 11
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: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
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	10
Total of all active and inactive participants	2013-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	10
Number of participants with account balances	2013-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	11
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	10
Total of all active and inactive participants	2012-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	10
Number of participants with account balances	2012-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	3
Number of retired or separated participants receiving benefits	2011-01-01	1
Number of other retired or separated participants entitled to future benefits	2011-01-01	7
Total of all active and inactive participants	2011-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	11
Number of participants with account balances	2011-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	1
2010: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	11
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	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	11
Number of participants with account balances	2010-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	11
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	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	11
Number of participants with account balances	2009-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN

Measure	Date	Value
2013 : ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$159,163
Total plan liabilities at beginning of year	2013-12-31	$182,100
Total income from all sources	2013-12-31	$43,271
Expenses. Total of all expenses incurred	2013-12-31	$16,752
Benefits paid (including direct rollovers)	2013-12-31	$13,866
Total plan assets at end of year	2013-12-31	$365,928
Total plan assets at beginning of year	2013-12-31	$362,346
Value of fidelity bond covering the plan	2013-12-31	$300,000
Contributions received from other sources (not participants or employers)	2013-12-31	$22,937
Other income received	2013-12-31	$20,334
Net income (gross income less expenses)	2013-12-31	$26,519
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$206,765
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$180,246
Assets. Value of real-estate (other than employer real property)	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$2,886
2012 : ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$182,100
Total plan liabilities at beginning of year	2012-12-31	$216,528
Total income from all sources	2012-12-31	$5,944
Expenses. Total of all expenses incurred	2012-12-31	$25,833
Benefits paid (including direct rollovers)	2012-12-31	$25,833
Total plan assets at end of year	2012-12-31	$362,346
Total plan assets at beginning of year	2012-12-31	$416,663
Value of fidelity bond covering the plan	2012-12-31	$300,000
Other income received	2012-12-31	$5,944
Net income (gross income less expenses)	2012-12-31	$-19,889
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$180,246
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$200,135
Assets. Value of participant loans	2012-12-31	$0
Assets. Value of real-estate (other than employer real property)	2012-12-31	$131,643
2011 : ROBERT B. CHAMBLISS, M.D. 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	$216,528
Total plan liabilities at beginning of year	2011-12-31	$237,409
Total income from all sources	2011-12-31	$67,565
Expenses. Total of all expenses incurred	2011-12-31	$44,189
Benefits paid (including direct rollovers)	2011-12-31	$7,339
Total plan assets at end of year	2011-12-31	$416,663
Total plan assets at beginning of year	2011-12-31	$414,168
Value of fidelity bond covering the plan	2011-12-31	$250,000
Total contributions received or receivable from participants	2011-12-31	$24,304
Expenses. Other expenses not covered elsewhere	2011-12-31	$36,726
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$20,512
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$23,376
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$200,135
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$176,759
Assets. Value of participant loans	2011-12-31	$1,432
Assets. Value of real-estate (other than employer real property)	2011-12-31	$412,000
Total contributions received or receivable from employer(s)	2011-12-31	$22,749
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	$124
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : ROBERT B. CHAMBLISS, M.D. 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	$237,409
Total plan liabilities at beginning of year	2010-12-31	$253,833
Total income from all sources	2010-12-31	$53,328
Expenses. Total of all expenses incurred	2010-12-31	$48,590
Benefits paid (including direct rollovers)	2010-12-31	$2,653
Total plan assets at end of year	2010-12-31	$414,168
Total plan assets at beginning of year	2010-12-31	$425,854
Value of fidelity bond covering the plan	2010-12-31	$250,000
Total contributions received or receivable from participants	2010-12-31	$27,326
Expenses. Other expenses not covered elsewhere	2010-12-31	$44,250
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$7,669
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$4,738
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$176,759
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$172,021
Assets. Value of real-estate (other than employer real property)	2010-12-31	$412,000
Total contributions received or receivable from employer(s)	2010-12-31	$18,333
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	$1,687
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN

2013: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING 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: ROBERT B. CHAMBLISS, M.D. 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
2010: ROBERT B. CHAMBLISS, M.D. PROFIT SHARING 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: ROBERT B. CHAMBLISS, M.D. 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:	ROBERT B. CHAMBLISS, M.D.
Employer identification number (EIN):	610621904
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)