401k Plan data: ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN plan

ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 401k Plan overview

Plan Name	ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN
Plan identification number	009

ST. CROIX ORTHOPAEDICS, P.A. 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).
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

ST. CROIX ORTHOPAEDICS, P.A. has sponsored the creation of one or more 401k plans.

Company Name: ST. CROIX ORTHOPAEDICS, P.A.

Employer identification number (EIN): 411334854

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
009 2014-01-01 MARK SHAROCKMAN MARK SHAROCKMAN 2015-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
009	2014-01-01	MARK SHAROCKMAN		MARK SHAROCKMAN	2015-10-13

Plan Statistics for ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN

401k plan membership statisitcs for ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN

Measure Date Value
2014: ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 137
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 6
Total of all active and inactive participants 2014-01-01 143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1

Measure	Date	Value
2014: ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	137
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	6
Total of all active and inactive participants	2014-01-01	143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1

Financial Data on ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN

Measure	Date	Value
2014 : ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$2,643
Total unrealized appreciation/depreciation of assets	2014-12-31	$2,643
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$822,642
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$819,999
Value of total assets at end of year	2014-12-31	$822,642
Value of total assets at beginning of year	2014-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$0
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$0
Administrative expenses (other) incurred	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$822,642
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$822,642
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$822,642
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$819,999
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	DS&B, LTD.
Accountancy firm EIN	2014-12-31	411475695

Form 5500 Responses for ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN

2014: ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

461245

Policy instance

Insurance contract or identification number	461245
Number of Individuals Covered	143
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $85
Total amount of fees paid to insurance company	USD $28
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $85
Insurance broker organization code?	3
Amount paid for insurance broker fees	28
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker name	TAX SHELTERED COMPENSATION INC

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Company Name:	ST. CROIX ORTHOPAEDICS, P.A.
Employer identification number (EIN):	411334854
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)