401k Plan data: JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN plan

JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 401k Plan overview

Plan Name	JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN
Plan identification number	004

JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Cash balance or similar plan - Plan has a "cash balance" formula. For this purpose, a "cash balance" formula is a benefit formula in a defined benefit plan by whatever name (for example, personal account plan, pension equity plan, life cycle plan, cash account plan, etc.) that rather than, or in addition to, expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee in terms more common to a defined contribution plan such as a single sum distribution amount (for example, 10 percent of final average pay times years of service, or the amount of the employee's hypothetical account balance).
Plan covering Self-Employed individuals.

401k Sponsoring company profile

JEFFREY S. SCHIFFMAN, M.D., INC. has sponsored the creation of one or more 401k plans.

Company Name: JEFFREY S. SCHIFFMAN, M.D., INC.

Employer identification number (EIN): 330625152

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
004 2012-01-01 JEFFREY SCHIFFMAN 2013-08-12 JEFFREY SCHIFFMAN 2013-08-12
004 2011-01-01 JEFFREY SCHIFFMAN JEFFREY SCHIFFMAN 2012-09-10
004 2010-01-01 JEFFREY SCHIFFMAN JEFFREY SCHIFFMAN 2011-09-12
004 2009-01-01 JEFFREY SCHIFFMAN JEFFREY SCHIFFMAN 2010-08-06

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
004	2012-01-01	JEFFREY SCHIFFMAN	2013-08-12	JEFFREY SCHIFFMAN	2013-08-12
004	2011-01-01	JEFFREY SCHIFFMAN		JEFFREY SCHIFFMAN	2012-09-10
004	2010-01-01	JEFFREY SCHIFFMAN		JEFFREY SCHIFFMAN	2011-09-12
004	2009-01-01	JEFFREY SCHIFFMAN		JEFFREY SCHIFFMAN	2010-08-06

Plan Statistics for JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN

401k plan membership statisitcs for JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN

Measure Date Value
2011: JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 6
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 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 7
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 1
Total of all active and inactive participants 2010-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 7
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 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2011: JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	6
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	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	7
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	1
Total of all active and inactive participants	2010-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	7
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	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN

Measure	Date	Value
2011 : JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$518
Total plan assets at end of year	2011-12-31	$289,911
Total plan assets at beginning of year	2011-12-31	$289,393
Other income received	2011-12-31	$518
Net income (gross income less expenses)	2011-12-31	$518
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$289,911
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$289,393
2010 : JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$113,970
Total plan assets at end of year	2010-12-31	$289,393
Total plan assets at beginning of year	2010-12-31	$175,423
Other income received	2010-12-31	$21,170
Net income (gross income less expenses)	2010-12-31	$113,970
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$289,393
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$175,423
Total contributions received or receivable from employer(s)	2010-12-31	$92,800

Form 5500 Responses for JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN

2011: JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: JEFFREY S. SCHIFFMAN, M.D., INC. CASH BALANCE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	JEFFREY S. SCHIFFMAN, M.D., INC.
Employer identification number (EIN):	330625152
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)