401k Plan data: MITCHEL R. GOLDMAN BASIC KEOGH PLAN plan

MITCHEL R. GOLDMAN BASIC KEOGH PLAN 401k Plan overview

Plan Name	MITCHEL R. GOLDMAN BASIC KEOGH PLAN
Plan identification number	001

MITCHEL R. GOLDMAN BASIC KEOGH PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Money purchase (other than target benefit)

401k Sponsoring company profile

MITCHEL R. GOLDMAN, DDS has sponsored the creation of one or more 401k plans.

Company Name: MITCHEL R. GOLDMAN, DDS

Employer identification number (EIN): 232729066

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MITCHEL R. GOLDMAN BASIC KEOGH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2016-01-01 NORBERT YAGLINSKI MITCHEL GOLDMAN 2017-06-05
001 2015-01-01 NORBERT YAGLINSKI MITCHEL GOLDMAN 2016-05-16
001 2014-01-01 NORBERT YAGLINSKI MITCHEL GOLDMAN 2015-09-14
001 2013-01-01 NORBERT YAGLINSKI MITCHEL GOLDMAN 2014-08-05
001 2012-01-01 NORBERT YAGLINSKI MITCHEL GOLDMAN 2013-07-09
001 2011-01-01 NORBERT YAGLINSKI MITCHEL GOLDMAN 2012-07-12
001 2009-01-01 NORBERT YAGLINSKI MITCHEL GOLDMAN 2010-06-24
001 2009-01-01 MITCHEL GOLDMAN 2010-06-08

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2016-01-01	NORBERT YAGLINSKI	MITCHEL GOLDMAN	2017-06-05
001	2015-01-01	NORBERT YAGLINSKI	MITCHEL GOLDMAN	2016-05-16
001	2014-01-01	NORBERT YAGLINSKI	MITCHEL GOLDMAN	2015-09-14
001	2013-01-01	NORBERT YAGLINSKI	MITCHEL GOLDMAN	2014-08-05
001	2012-01-01	NORBERT YAGLINSKI	MITCHEL GOLDMAN	2013-07-09
001	2011-01-01	NORBERT YAGLINSKI	MITCHEL GOLDMAN	2012-07-12
001	2009-01-01	NORBERT YAGLINSKI	MITCHEL GOLDMAN	2010-06-24
001	2009-01-01		MITCHEL GOLDMAN	2010-06-08

Plan Statistics for MITCHEL R. GOLDMAN BASIC KEOGH PLAN

401k plan membership statisitcs for MITCHEL R. GOLDMAN BASIC KEOGH PLAN

Measure Date Value
2016: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Number of participants with account balances 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 1
Number of participants with account balances 2015-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
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 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1
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 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 1
Number of participants with account balances 2013-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1
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 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 1
Number of participants with account balances 2012-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1
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 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 1
Number of participants with account balances 2011-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 0
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 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 1
Number of participants with account balances 2009-01-01 1

Measure	Date	Value
2016: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Number of participants with account balances	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	1
Number of participants with account balances	2015-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
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	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1
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	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	1
Number of participants with account balances	2013-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1
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	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	1
Number of participants with account balances	2012-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1
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	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	1
Number of participants with account balances	2011-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	0
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	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1
Number of participants with account balances	2009-01-01	1

Financial Data on MITCHEL R. GOLDMAN BASIC KEOGH PLAN

Measure	Date	Value
2016 : MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$5,766
Expenses. Total of all expenses incurred	2016-12-31	$205,222
Benefits paid (including direct rollovers)	2016-12-31	$205,222
Total plan assets at end of year	2016-12-31	$0
Total plan assets at beginning of year	2016-12-31	$199,456
Other income received	2016-12-31	$5,766
Net income (gross income less expenses)	2016-12-31	$-199,456
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$199,456
2015 : MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$-10,265
Expenses. Total of all expenses incurred	2015-12-31	$15,105
Benefits paid (including direct rollovers)	2015-12-31	$15,105
Total plan assets at end of year	2015-12-31	$199,456
Total plan assets at beginning of year	2015-12-31	$224,826
Other income received	2015-12-31	$-10,265
Net income (gross income less expenses)	2015-12-31	$-25,370
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$199,456
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$224,826
2014 : MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$-325
Expenses. Total of all expenses incurred	2014-12-31	$14,961
Benefits paid (including direct rollovers)	2014-12-31	$14,961
Total plan assets at end of year	2014-12-31	$224,826
Total plan assets at beginning of year	2014-12-31	$240,112
Other income received	2014-12-31	$-325
Net income (gross income less expenses)	2014-12-31	$-15,286
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$224,826
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$240,112
2013 : MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$35,009
Expenses. Total of all expenses incurred	2013-12-31	$15,105
Benefits paid (including direct rollovers)	2013-12-31	$15,105
Total plan assets at end of year	2013-12-31	$240,112
Total plan assets at beginning of year	2013-12-31	$220,208
Other income received	2013-12-31	$35,009
Net income (gross income less expenses)	2013-12-31	$19,904
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$240,112
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$220,208
2012 : MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$13,213
Total plan assets at end of year	2012-12-31	$220,208
Total plan assets at beginning of year	2012-12-31	$206,995
Other income received	2012-12-31	$13,213
Net income (gross income less expenses)	2012-12-31	$13,213
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$220,208
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$206,995
2011 : MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$-10,660
Total plan assets at end of year	2011-12-31	$206,995
Total plan assets at beginning of year	2011-12-31	$217,655
Other income received	2011-12-31	$-10,660
Net income (gross income less expenses)	2011-12-31	$-10,660
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$206,995
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$217,655
2010 : MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$17,458
Total plan assets at end of year	2010-12-31	$217,655
Total plan assets at beginning of year	2010-12-31	$200,197
Value of fidelity bond covering the plan	2010-12-31	$25,000
Other income received	2010-12-31	$17,458
Net income (gross income less expenses)	2010-12-31	$17,458
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$217,655
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$200,197

Form 5500 Responses for MITCHEL R. GOLDMAN BASIC KEOGH PLAN

2016: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	This submission is the final filing	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: MITCHEL R. GOLDMAN BASIC KEOGH 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
2009: MITCHEL R. GOLDMAN BASIC KEOGH PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	MITCHEL R. GOLDMAN, DDS
Employer identification number (EIN):	232729066
NAIC Classification:	621210
NAIC Description:	Offices of Dentists