401k Plan data: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN plan

ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 401k Plan overview

Plan Name	ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN
Plan identification number	001

ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT 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.
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

ALFRED L. SHAW, P.C. has sponsored the creation of one or more 401k plans.

Company Name: ALFRED L. SHAW, P.C.

Employer identification number (EIN): 381873790

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Additional information about ALFRED L. SHAW, P.C.

Jurisdiction of Incorporation: Michigan Secretary of State

Incorporation Date: 0000-00-00

Company Identification Number: 130274

Legal Registered Office Address: W SEVEN MILE LIVONIA 48152

United States of America (USA)
33627

More information about ALFRED L. SHAW, P.C.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
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
001 2015-01-01
001 2014-01-01 RANDALL L. SHAW, DDS, MS
001 2013-01-01 RANDALL L. SHAW, DDS, MS
001 2012-01-01 RANDALL L. SHAW, DDS, MS
001 2011-01-01 JENNIFER RICHTER AS PRACTITIONER
001 2010-01-01 JENNIFER RICHTER AS PRACTITIONER
001 2009-01-01 JAMES A. GINZLER

Plan Statistics for ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN

401k plan membership statisitcs for ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN

Measure Date Value
2014: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 23
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 23
Number of participants with account balances 2014-01-01 23
2013: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 22
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 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 22
Number of participants with account balances 2013-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 24
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 23
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 23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 23
Number of participants with account balances 2012-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 3
2011: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 24
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 24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 24
Number of participants with account balances 2011-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 2
2010: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 26
Number of retired or separated participants receiving benefits 2010-01-01 23
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 23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 23
Number of participants with account balances 2010-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 2
2009: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING 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 25
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 1
Total of all active and inactive participants 2009-01-01 26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 26
Number of participants with account balances 2009-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2014: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	23
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	23
Number of participants with account balances	2014-01-01	23
2013: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	22
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	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	22
Number of participants with account balances	2013-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	24
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	23
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	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	23
Number of participants with account balances	2012-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	3
2011: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	24
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	24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	24
Number of participants with account balances	2011-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	2
2010: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	26
Number of retired or separated participants receiving benefits	2010-01-01	23
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	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	23
Number of participants with account balances	2010-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	2
2009: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING 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	25
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	1
Total of all active and inactive participants	2009-01-01	26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	26
Number of participants with account balances	2009-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN

Measure	Date	Value
2014 : ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$174,784
Expenses. Total of all expenses incurred	2014-12-31	$5,805
Benefits paid (including direct rollovers)	2014-12-31	$5,805
Total plan assets at end of year	2014-12-31	$2,103,989
Total plan assets at beginning of year	2014-12-31	$1,935,010
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$51,654
Contributions received from other sources (not participants or employers)	2014-12-31	$19,918
Other income received	2014-12-31	$27,189
Net income (gross income less expenses)	2014-12-31	$168,979
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$2,103,989
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,935,010
Assets. Value of participant loans	2014-12-31	$8,909
Assets. Value of real-estate (other than employer real property)	2014-12-31	$76,000
Total contributions received or receivable from employer(s)	2014-12-31	$76,023
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$404,000
Expenses. Total of all expenses incurred	2013-12-31	$14,455
Benefits paid (including direct rollovers)	2013-12-31	$14,455
Total plan assets at end of year	2013-12-31	$1,935,010
Total plan assets at beginning of year	2013-12-31	$1,545,465
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$52,315
Other income received	2013-12-31	$289,456
Net income (gross income less expenses)	2013-12-31	$389,545
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,935,010
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,545,465
Assets. Value of real-estate (other than employer real property)	2013-12-31	$76,000
Total contributions received or receivable from employer(s)	2013-12-31	$62,229
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$341,354
Expenses. Total of all expenses incurred	2012-12-31	$57,613
Benefits paid (including direct rollovers)	2012-12-31	$39,906
Total plan assets at end of year	2012-12-31	$1,545,465
Total plan assets at beginning of year	2012-12-31	$1,261,724
Value of fidelity bond covering the plan	2012-12-31	$500,000
Total contributions received or receivable from participants	2012-12-31	$25,484
Assets. Value of loans (other than to participants)	2012-12-31	$76,000
Other income received	2012-12-31	$212,325
Net income (gross income less expenses)	2012-12-31	$283,741
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,545,465
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,261,724
Total contributions received or receivable from employer(s)	2012-12-31	$103,545
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$17,707
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$-75,931
Expenses. Total of all expenses incurred	2011-12-31	$2,385,299
Benefits paid (including direct rollovers)	2011-12-31	$2,367,896
Total plan assets at end of year	2011-12-31	$1,261,724
Total plan assets at beginning of year	2011-12-31	$3,722,954
Value of fidelity bond covering the plan	2011-12-31	$500,000
Assets. Value of loans (other than to participants)	2011-12-31	$76,000
Other income received	2011-12-31	$-176,712
Net income (gross income less expenses)	2011-12-31	$-2,461,230
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,261,724
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$3,722,954
Total contributions received or receivable from employer(s)	2011-12-31	$100,781
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$17,403
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$288,608
Expenses. Total of all expenses incurred	2010-12-31	$11,444
Benefits paid (including direct rollovers)	2010-12-31	$11,444
Total plan assets at end of year	2010-12-31	$3,722,954
Total plan assets at beginning of year	2010-12-31	$3,445,790
Value of fidelity bond covering the plan	2010-12-31	$555,000
Assets. Value of loans (other than to participants)	2010-12-31	$76,000
Other income received	2010-12-31	$155,862
Net income (gross income less expenses)	2010-12-31	$277,164
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$3,722,954
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$3,445,790
Total contributions received or receivable from employer(s)	2010-12-31	$132,746
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT 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 ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN

2014: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT 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: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT 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: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT 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 – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT 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 – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: ALFRED L. SHAW, P.C. EMPLOYEES RETIREMENT 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 – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

60136776

Policy instance

Insurance contract or identification number	60136776
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

60136776

Policy instance

Insurance contract or identification number	60136776
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	ALFRED L. SHAW, P.C.
Employer identification number (EIN):	381873790
NAIC Classification:	621210
NAIC Description:	Offices of Dentists

Jurisdiction of Incorporation:	Michigan Secretary of State
Incorporation Date:	0000-00-00
Company Identification Number:	130274
Legal Registered Office Address:	W SEVEN MILE LIVONIA 48152 United States of America (USA) 33627

Plan id#	Filing Submission Date	Name of Administrator
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
001	2015-01-01
001	2014-01-01	RANDALL L. SHAW, DDS, MS
001	2013-01-01	RANDALL L. SHAW, DDS, MS
001	2012-01-01	RANDALL L. SHAW, DDS, MS
001	2011-01-01	JENNIFER RICHTER AS PRACTITIONER
001	2010-01-01	JENNIFER RICHTER AS PRACTITIONER
001	2009-01-01	JAMES A. GINZLER