401k Plan data: BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN plan

BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN 401k Plan overview

Plan Name	BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN
Plan identification number	002

BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Money purchase (other than target benefit) Plan covering Self-Employed individuals. Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

BARRY J. GROSSMAN has sponsored the creation of one or more 401k plans.

Company Name: BARRY J. GROSSMAN

Employer identification number (EIN): 112734129

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2017-01-01 BARRY GROSSMAN 2018-10-10 BARRY GROSSMAN 2018-10-10
002 2016-01-01 BARRY GROSSMAN 2017-10-12 BARRY GROSSMAN 2017-10-12
002 2015-01-01 BARRY GROSSMAN 2016-10-13 BARRY GROSSMAN 2016-10-13
002 2014-01-01 BARRY GROSSMAN 2015-10-14 BARRY GROSSMAN 2015-10-14
002 2013-01-01 BARRY GROSSMAN 2014-10-15 BARRY GROSSMAN 2014-10-15
002 2012-01-01 BARRY GROSSMAN 2013-10-15
002 2011-01-01 BARRY GROSSMAN
002 2010-01-01 BARRY GROSSMAN
002 2009-01-01 BARRY GROSSMAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2017-01-01	BARRY GROSSMAN	2018-10-10	BARRY GROSSMAN	2018-10-10
002	2016-01-01	BARRY GROSSMAN	2017-10-12	BARRY GROSSMAN	2017-10-12
002	2015-01-01	BARRY GROSSMAN	2016-10-13	BARRY GROSSMAN	2016-10-13
002	2014-01-01	BARRY GROSSMAN	2015-10-14	BARRY GROSSMAN	2015-10-14
002	2013-01-01	BARRY GROSSMAN	2014-10-15	BARRY GROSSMAN	2014-10-15
002	2012-01-01	BARRY GROSSMAN	2013-10-15
002	2011-01-01	BARRY GROSSMAN
002	2010-01-01	BARRY GROSSMAN
002	2009-01-01	BARRY GROSSMAN

Plan Statistics for BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN

401k plan membership statisitcs for BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN

Measure Date Value
2011: BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 2
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 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: BARREY J. GROSSMAN SELF EMPLOYED 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 1
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 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 1
Number of participants with account balances 2010-01-01 2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: BARREY J. GROSSMAN SELF EMPLOYED 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 1
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 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 2
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: BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	2
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	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: BARREY J. GROSSMAN SELF EMPLOYED 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	1
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	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	1
Number of participants with account balances	2010-01-01	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: BARREY J. GROSSMAN SELF EMPLOYED 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	1
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	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	2
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN

Measure	Date	Value
2011 : BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$23,391
Expenses. Total of all expenses incurred	2011-12-31	$6,118
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$318,467
Total plan assets at beginning of year	2011-12-31	$301,194
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$6,118
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$0
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$17,273
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$318,467
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$301,194
Total contributions received or receivable from employer(s)	2011-12-31	$23,391
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
2010 : BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$24,192
Expenses. Total of all expenses incurred	2010-12-31	$0
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$301,194
Total plan assets at beginning of year	2010-12-31	$277,002
Total contributions received or receivable from participants	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$6,775
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$24,192
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$301,194
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$277,002
Total contributions received or receivable from employer(s)	2010-12-31	$17,417
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0

Form 5500 Responses for BARREY J. GROSSMAN SELF EMPLOYED PENSION PLAN

2011: BARREY J. GROSSMAN SELF EMPLOYED PENSION 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: BARREY J. GROSSMAN SELF EMPLOYED PENSION 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: BARREY J. GROSSMAN SELF EMPLOYED PENSION 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

MONY LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 66370 )

Policy contract number

901946

Policy instance

Insurance contract or identification number	901946
Number of Individuals Covered	2
Insurance policy start date	1986-01-01
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MONY LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 66370 )

Policy contract number

901946

Policy instance

Insurance contract or identification number	901946
Number of Individuals Covered	2
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BARRY J. GROSSMAN
Employer identification number (EIN):	112734129
NAIC Classification:	621210
NAIC Description:	Offices of Dentists