401k Plan data: MITCHELL ROTHSTEIN 412I PENSION PLAN plan

MITCHELL ROTHSTEIN 412I PENSION PLAN 401k Plan overview

Plan Name	MITCHELL ROTHSTEIN 412I PENSION PLAN
Plan identification number	001

MITCHELL ROTHSTEIN 412I PENSION PLAN Benefits

401k Plan Type	Defined Benefit Pension
Plan Features/Benefits	Benefits are primarily pay related 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

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

Company Name: MITCHELL S ROTHSTEIN M.D., INC

Employer identification number (EIN): 593665561

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MITCHELL ROTHSTEIN 412I PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2012-01-01 MITCHELL ROTHSTEIN
001 2010-01-01 MITCHELL ROTHSTEIN
001 2009-01-01 MITCHELL ROTHSTEIN

Plan id#	Filing Submission Date	Name of Administrator
001	2012-01-01	MITCHELL ROTHSTEIN
001	2010-01-01	MITCHELL ROTHSTEIN
001	2009-01-01	MITCHELL ROTHSTEIN

Plan Statistics for MITCHELL ROTHSTEIN 412I PENSION PLAN

401k plan membership statisitcs for MITCHELL ROTHSTEIN 412I PENSION PLAN

Measure Date Value
2012: MITCHELL ROTHSTEIN 412I PENSION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2
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 0
Total of all active and inactive participants 2012-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2010: MITCHELL ROTHSTEIN 412I PENSION PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 2
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 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 2
2009: MITCHELL ROTHSTEIN 412I PENSION PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 2
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 2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 2

Measure	Date	Value
2012: MITCHELL ROTHSTEIN 412I PENSION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2
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	0
Total of all active and inactive participants	2012-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2010: MITCHELL ROTHSTEIN 412I PENSION PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	2
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	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	2
2009: MITCHELL ROTHSTEIN 412I PENSION PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	2
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	2
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	2

Financial Data on MITCHELL ROTHSTEIN 412I PENSION PLAN

Measure	Date	Value
2012 : MITCHELL ROTHSTEIN 412I PENSION PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$-1,090,436
Total income from all sources	2012-12-31	$32,097
Total plan assets at end of year	2012-12-31	$0
Total plan assets at beginning of year	2012-12-31	$1,058,339
Other income received	2012-12-31	$32,097
Net income (gross income less expenses)	2012-12-31	$32,097
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,058,339
2010 : MITCHELL ROTHSTEIN 412I PENSION PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$119,097
Total plan assets at end of year	2010-12-31	$937,478
Total plan assets at beginning of year	2010-12-31	$818,381
Other income received	2010-12-31	$27,822
Net income (gross income less expenses)	2010-12-31	$119,097
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$937,478
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$818,381
Total contributions received or receivable from employer(s)	2010-12-31	$91,275

Form 5500 Responses for MITCHELL ROTHSTEIN 412I PENSION PLAN

2012: MITCHELL ROTHSTEIN 412I PENSION PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	This submission is the final filing	Yes
2012-01-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2012-01-01	Plan benefit arrangement – Section 412(e)(3) insurance Contracts	Yes
2010: MITCHELL ROTHSTEIN 412I PENSION PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2010-01-01	Plan benefit arrangement – Section 412(e)(3) insurance Contracts	Yes
2009: MITCHELL ROTHSTEIN 412I PENSION PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Section 412(e)(3) insurance Contracts	Yes
2009-01-01	Plan benefit arrangement – Section 412(e)(3) insurance Contracts	Yes

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Company Name:	MITCHELL S ROTHSTEIN M.D., INC
Employer identification number (EIN):	593665561
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)