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Lew B. Sample, D.M.D.,M.S., P.C.

Details

Name: Lew B. Sample, D.M.D.,M.S., P.C.
Jurisdiction: Alabama
Legal type: Domestic Professional Corporation
Status: Exists
Date of registration: 21 Dec 1998 (26 years ago)
Entity Number: 000-199-568
Register Number: 000199568
County: Morgan
Place of Formation: Morgan County
Principal Address: DECATUR, AL
Registered Office Street Address: 2014 DANVILLE PARK DRIVE SWDECATUR, AL 35603
Registered Office Street Address ZIP Code: 35603
Authorized Capital: $1,000

Activities PRACTICE OF DENTISTRY/ORAL SURGERY

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
LEW B. SAMPLE, D.M.D., M.S., P.C. CASH BALANCE PLAN 2023 631214809 2024-09-27 LEW B. SAMPLE, D.M.D., M.S., P.C. 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2523555255
Plan sponsor’s address 2014 DANVILLE PARK DR., DECATUR, AL, 35603

Signature of
Role Plan administrator
Date 2024-09-27
Name of individual signing LEW SAMPLE
Valid signature Filed with authorized/valid electronic signature
LEW B. SAMPLE, D.M.D., M.S., P.C. 401(K) PROFIT SHARING PLAN 2023 631214809 2024-06-17 LEW B. SAMPLE, D.M.D., M.S., P.C. 19
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 2523555255
Plan sponsor’s address 2014 DANVILLE PARK DR., DECATUR, AL, 35603

Signature of
Role Plan administrator
Date 2024-06-17
Name of individual signing LEW SAMPLE
LEW B. SAMPLE, D.M.D., M.S., P.C. CASH BALANCE PLAN 2022 631214809 2023-06-15 LEW B. SAMPLE, D.M.D., M.S., P.C. 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2523555255
Plan sponsor’s address 2014 DANVILLE PARK ROAD, DECATUR, AL, 35603

Signature of
Role Plan administrator
Date 2023-06-15
Name of individual signing LEW SAMPLE
LEW B. SAMPLE, D.M.D., M.S., P.C. 401(K) PROFIT SHARING PLAN 2022 631214809 2023-09-25 LEW B. SAMPLE, D.M.D., M.S., P.C. 18
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 2523555255
Plan sponsor’s address 2014 DANVILLE PARK DR., DECATUR, AL, 35603

Signature of
Role Plan administrator
Date 2023-09-25
Name of individual signing LEW SAMPLE
LEW B. SAMPLE, D.M.D., M.S., P.C. CASH BALANCE PLAN 2021 631214809 2022-09-30 LEW B. SAMPLE, D.M.D., M.S., P.C. 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2523555255
Plan sponsor’s address 2014 DANVILLE PARK ROAD, DECATUR, AL, 35603

Signature of
Role Plan administrator
Date 2022-09-30
Name of individual signing LEW SAMPLE
LEW B. SAMPLE, D.M.D., M.S., P.C. 401(K) PROFIT SHARING PLAN 2021 631214809 2022-09-30 LEW B. SAMPLE, D.M.D., M.S., P.C. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 2563555255
Plan sponsor’s address 2014 DANVILLE PARK ROAD, DECATUR, AL, 35603

Signature of
Role Plan administrator
Date 2022-09-30
Name of individual signing LEW SAMPLE
LEW B. SAMPLE, D.M.D., M.S., P.C. 401(K) PROFIT SHARING PLAN 2020 631214809 2021-10-04 LEW B. SAMPLE, D.M.D., M.S., P.C. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 2563555255
Plan sponsor’s address 2014 DANVILLE PARK ROAD, DECATUR, AL, 35603

Signature of
Role Plan administrator
Date 2021-10-04
Name of individual signing LEW SAMPLE
LEW B. SAMPLE, D.M.D., M.S., P.C. CASH BALANCE PLAN 2020 631214809 2021-10-04 LEW B. SAMPLE, D.M.D., M.S., P.C. 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2523555255
Plan sponsor’s address 2014 DANVILLE PARK ROAD, DECATUR, AL, 35603

Signature of
Role Plan administrator
Date 2021-10-04
Name of individual signing LEW SAMPLE
LEW B. SAMPLE, DMD, MS, PC 401(K) PROFIT SHARING 2019 631214809 2020-06-19 LEW B. SAMPLE, D.M.D., M.S., P.C. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2001-01-01
Business code 621210
Sponsor’s telephone number 2563555255
Plan sponsor’s address 1323 STRATFORD ROAD SE, DECATUR, AL, 35601

Signature of
Role Plan administrator
Date 2020-06-19
Name of individual signing LEW SAMPLE
LEW B. SAMPLE, D.M.D., M.S., P.C. CASH BALANCE PLAN 2019 631214809 2020-06-19 LEW B. SAMPLE, D.M.D., M.S., P.C. 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2016-01-01
Business code 621210
Sponsor’s telephone number 2523555255
Plan sponsor’s address 2014 DANVILLE PARK ROAD, DECATUR, AL, 35603

Signature of
Role Plan administrator
Date 2020-06-19
Name of individual signing LEW SAMPLE

Agent

Name Role
SAMPLE, LEW B Agent

Incorporator

Name Role
SAMPLE, LEW B Incorporator

Related by officers

No related officers

Related by address

DECATUR, AL

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Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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