401k Plan data: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN plan

COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 401k Plan overview

Plan Name	COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN
Plan identification number	002

COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Participant-directed brokerage accounts provided as an investment option under the plan.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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.
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

COLORADO SPRINGS SURGICAL ASSOCIATES, PC has sponsored the creation of one or more 401k plans.

Company Name: COLORADO SPRINGS SURGICAL ASSOCIATES, PC

Employer identification number (EIN): 840701367

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01 DAVID HAMILTON 2023-10-16
002 2021-01-01 IHOR FEDORAK, MD 2022-07-27
002 2020-01-01 IHOR FEDORAK, MD 2021-04-20
002 2019-01-01 IHOR FEDORAK, MD 2020-06-08
002 2018-01-01
002 2017-01-01
002 2016-01-01 WILLIAM C. CHAMBERS, MD WILLIAM C. CHAMBERS, MD 2017-08-28
002 2015-01-01 WILLIAM C. CHAMBERS, MD WILLIAM C. CHAMBERS, MD 2016-09-12
002 2014-01-01 WILLIAM C. CHAMBERS, MD WILLIAM C. CHAMBERS, MD 2015-10-13
002 2013-01-01 WILLIAM C. CHAMBERS, MD WILLIAM C. CHAMBERS, MD 2014-09-30
002 2012-01-01 WILLIAM C. CHAMBERS, MD WILLIAM C. CHAMBERS, MD 2013-07-22
002 2011-01-01 WILLIAM C. CHAMBERS, MD WILLIAM C. CHAMBERS, MD 2012-10-11
002 2009-01-01 WILLIAM C. CHAMBERS, MD WILLIAM C. CHAMBERS, MD 2010-08-02

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01	DAVID HAMILTON	2023-10-16
002	2021-01-01	IHOR FEDORAK, MD	2022-07-27
002	2020-01-01	IHOR FEDORAK, MD	2021-04-20
002	2019-01-01	IHOR FEDORAK, MD	2020-06-08
002	2018-01-01
002	2017-01-01
002	2016-01-01	WILLIAM C. CHAMBERS, MD		WILLIAM C. CHAMBERS, MD	2017-08-28
002	2015-01-01	WILLIAM C. CHAMBERS, MD		WILLIAM C. CHAMBERS, MD	2016-09-12
002	2014-01-01	WILLIAM C. CHAMBERS, MD		WILLIAM C. CHAMBERS, MD	2015-10-13
002	2013-01-01	WILLIAM C. CHAMBERS, MD		WILLIAM C. CHAMBERS, MD	2014-09-30
002	2012-01-01	WILLIAM C. CHAMBERS, MD		WILLIAM C. CHAMBERS, MD	2013-07-22
002	2011-01-01	WILLIAM C. CHAMBERS, MD		WILLIAM C. CHAMBERS, MD	2012-10-11
002	2009-01-01	WILLIAM C. CHAMBERS, MD		WILLIAM C. CHAMBERS, MD	2010-08-02

Plan Statistics for COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN

401k plan membership statisitcs for COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN

Measure Date Value
2022: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 14
Number of retired or separated participants receiving benefits 2022-01-01 1
Number of other retired or separated participants entitled to future benefits 2022-01-01 9
Total of all active and inactive participants 2022-01-01 24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 24
Number of participants with account balances 2022-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 13
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 6
Total of all active and inactive participants 2021-01-01 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 19
Number of participants with account balances 2021-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 30
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 11
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 7
Total of all active and inactive participants 2020-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 18
Number of participants with account balances 2020-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 34
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 10
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 20
Total of all active and inactive participants 2019-01-01 30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 30
Number of participants with account balances 2019-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 33
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 19
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 11
Total of all active and inactive participants 2018-01-01 30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 30
Number of participants with account balances 2018-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 33
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 24
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 6
Total of all active and inactive participants 2017-01-01 31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 31
Number of participants with account balances 2017-01-01 31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 16
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 12
Total of all active and inactive participants 2016-01-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 28
Number of participants with account balances 2016-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 24
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 20
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 8
Total of all active and inactive participants 2015-01-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 28
Number of participants with account balances 2015-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 19
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 5
Total of all active and inactive participants 2014-01-01 24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 24
Number of participants with account balances 2014-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 18
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 4
Total of all active and inactive participants 2013-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 22
Number of participants with account balances 2013-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 19
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 2
Total of all active and inactive participants 2012-01-01 21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 21
Number of participants with account balances 2012-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 25
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 20
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 2
Total of all active and inactive participants 2011-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 22
Number of participants with account balances 2011-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 19
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 3
Total of all active and inactive participants 2009-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 22
Number of participants with account balances 2009-01-01 22

Measure	Date	Value
2022: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	14
Number of retired or separated participants receiving benefits	2022-01-01	1
Number of other retired or separated participants entitled to future benefits	2022-01-01	9
Total of all active and inactive participants	2022-01-01	24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	24
Number of participants with account balances	2022-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	13
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	6
Total of all active and inactive participants	2021-01-01	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	19
Number of participants with account balances	2021-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	30
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	11
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	7
Total of all active and inactive participants	2020-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	18
Number of participants with account balances	2020-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	34
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	10
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	20
Total of all active and inactive participants	2019-01-01	30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	30
Number of participants with account balances	2019-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	33
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	19
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	11
Total of all active and inactive participants	2018-01-01	30
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	30
Number of participants with account balances	2018-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	33
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	24
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	6
Total of all active and inactive participants	2017-01-01	31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	31
Number of participants with account balances	2017-01-01	31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	16
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	12
Total of all active and inactive participants	2016-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	28
Number of participants with account balances	2016-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	24
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	20
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	8
Total of all active and inactive participants	2015-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	28
Number of participants with account balances	2015-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	19
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	5
Total of all active and inactive participants	2014-01-01	24
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	24
Number of participants with account balances	2014-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	18
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	4
Total of all active and inactive participants	2013-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	22
Number of participants with account balances	2013-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	19
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	2
Total of all active and inactive participants	2012-01-01	21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	21
Number of participants with account balances	2012-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	25
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	20
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	2
Total of all active and inactive participants	2011-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	22
Number of participants with account balances	2011-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	19
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	3
Total of all active and inactive participants	2009-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	22
Number of participants with account balances	2009-01-01	22

Financial Data on COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN

Measure	Date	Value
2022 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2022 401k financial data
Total income from all sources	2022-12-31	$-297,353
Expenses. Total of all expenses incurred	2022-12-31	$750,504
Benefits paid (including direct rollovers)	2022-12-31	$713,591
Total plan assets at end of year	2022-12-31	$5,417,243
Total plan assets at beginning of year	2022-12-31	$6,465,100
Value of fidelity bond covering the plan	2022-12-31	$1,000,000
Total contributions received or receivable from participants	2022-12-31	$258,382
Other income received	2022-12-31	$-854,924
Net income (gross income less expenses)	2022-12-31	$-1,047,857
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$5,417,243
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$6,465,100
Assets. Value of assets in partnership/joint-venture interests	2022-12-31	$50,000
Total contributions received or receivable from employer(s)	2022-12-31	$299,189
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$36,913
2021 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources	2021-12-31	$1,394,726
Expenses. Total of all expenses incurred	2021-12-31	$48,617
Benefits paid (including direct rollovers)	2021-12-31	$17,847
Total plan assets at end of year	2021-12-31	$6,465,100
Total plan assets at beginning of year	2021-12-31	$5,118,991
Value of fidelity bond covering the plan	2021-12-31	$1,000,000
Total contributions received or receivable from participants	2021-12-31	$167,303
Other income received	2021-12-31	$989,328
Net income (gross income less expenses)	2021-12-31	$1,346,109
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$6,465,100
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$5,118,991
Assets. Value of assets in partnership/joint-venture interests	2021-12-31	$200,000
Total contributions received or receivable from employer(s)	2021-12-31	$238,095
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$30,770
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
2020 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources	2020-12-31	$807,215
Expenses. Total of all expenses incurred	2020-12-31	$173,011
Benefits paid (including direct rollovers)	2020-12-31	$149,483
Total plan assets at end of year	2020-12-31	$5,118,991
Total plan assets at beginning of year	2020-12-31	$4,484,787
Value of fidelity bond covering the plan	2020-12-31	$1,000,000
Total contributions received or receivable from participants	2020-12-31	$165,545
Other income received	2020-12-31	$387,792
Net income (gross income less expenses)	2020-12-31	$634,204
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$5,118,991
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$4,484,787
Assets. Value of participant loans	2020-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2020-12-31	$200,000
Total contributions received or receivable from employer(s)	2020-12-31	$253,878
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$23,528
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$1,426,110
Expenses. Total of all expenses incurred	2019-12-31	$2,013,379
Benefits paid (including direct rollovers)	2019-12-31	$1,987,598
Total plan assets at end of year	2019-12-31	$4,484,787
Total plan assets at beginning of year	2019-12-31	$5,072,056
Value of fidelity bond covering the plan	2019-12-31	$1,000,000
Total contributions received or receivable from participants	2019-12-31	$153,367
Other income received	2019-12-31	$997,209
Net income (gross income less expenses)	2019-12-31	$-587,269
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$4,484,787
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$5,072,056
Assets. Value of participant loans	2019-12-31	$1,763
Assets. Value of assets in partnership/joint-venture interests	2019-12-31	$200,000
Total contributions received or receivable from employer(s)	2019-12-31	$275,534
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$25,781
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2018 401k financial data
Total plan liabilities at beginning of year	2018-12-31	$0
Total income from all sources	2018-12-31	$44,080
Expenses. Total of all expenses incurred	2018-12-31	$1,832,279
Benefits paid (including direct rollovers)	2018-12-31	$1,787,051
Total plan assets at end of year	2018-12-31	$5,072,056
Total plan assets at beginning of year	2018-12-31	$6,860,255
Value of fidelity bond covering the plan	2018-12-31	$1,000,000
Total contributions received or receivable from participants	2018-12-31	$191,153
Other income received	2018-12-31	$-496,132
Net income (gross income less expenses)	2018-12-31	$-1,788,199
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$5,072,056
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$6,860,255
Assets. Value of participant loans	2018-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2018-12-31	$200,000
Total contributions received or receivable from employer(s)	2018-12-31	$349,059
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$45,228
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2017 401k financial data
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$237
Total income from all sources	2017-12-31	$1,234,062
Expenses. Total of all expenses incurred	2017-12-31	$225,603
Benefits paid (including direct rollovers)	2017-12-31	$180,168
Total plan assets at end of year	2017-12-31	$6,860,255
Total plan assets at beginning of year	2017-12-31	$5,852,033
Value of fidelity bond covering the plan	2017-12-31	$1,000,000
Total contributions received or receivable from participants	2017-12-31	$181,820
Other income received	2017-12-31	$726,080
Net income (gross income less expenses)	2017-12-31	$1,008,459
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$6,860,255
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$5,851,796
Assets. Value of participant loans	2017-12-31	$8,483
Assets. Value of assets in partnership/joint-venture interests	2017-12-31	$200,000
Total contributions received or receivable from employer(s)	2017-12-31	$326,162
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$45,435
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-12-31	$237
Total income from all sources	2016-12-31	$1,207,543
Expenses. Total of all expenses incurred	2016-12-31	$561,869
Benefits paid (including direct rollovers)	2016-12-31	$499,257
Total plan assets at end of year	2016-12-31	$5,852,033
Total plan assets at beginning of year	2016-12-31	$5,206,122
Value of fidelity bond covering the plan	2016-12-31	$1,000,000
Total contributions received or receivable from participants	2016-12-31	$166,337
Expenses. Other expenses not covered elsewhere	2016-12-31	$46
Contributions received from other sources (not participants or employers)	2016-12-31	$5,479
Other income received	2016-12-31	$737,413
Net income (gross income less expenses)	2016-12-31	$645,674
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$5,851,796
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$5,206,122
Assets. Value of participant loans	2016-12-31	$21,010
Assets. Value of assets in partnership/joint-venture interests	2016-12-31	$200,000
Total contributions received or receivable from employer(s)	2016-12-31	$298,314
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$62,566
2015 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$219,154
Expenses. Total of all expenses incurred	2015-12-31	$82,895
Benefits paid (including direct rollovers)	2015-12-31	$19,843
Total plan assets at end of year	2015-12-31	$5,206,122
Total plan assets at beginning of year	2015-12-31	$5,069,863
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$147,329
Expenses. Other expenses not covered elsewhere	2015-12-31	$521
Other income received	2015-12-31	$-198,656
Net income (gross income less expenses)	2015-12-31	$136,259
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$5,206,122
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$5,069,863
Assets. Value of participant loans	2015-12-31	$40,773
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$75,000
Total contributions received or receivable from employer(s)	2015-12-31	$270,481
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$62,531
2014 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$717,246
Expenses. Total of all expenses incurred	2014-12-31	$438,085
Benefits paid (including direct rollovers)	2014-12-31	$377,578
Total plan assets at end of year	2014-12-31	$5,069,863
Total plan assets at beginning of year	2014-12-31	$4,790,702
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$152,215
Expenses. Other expenses not covered elsewhere	2014-12-31	$517
Other income received	2014-12-31	$315,495
Net income (gross income less expenses)	2014-12-31	$279,161
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$5,069,863
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$4,790,702
Assets. Value of participant loans	2014-12-31	$66,225
Assets. Value of assets in partnership/joint-venture interests	2014-12-31	$75,000
Total contributions received or receivable from employer(s)	2014-12-31	$249,536
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$59,990
2013 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$1,206,224
Expenses. Total of all expenses incurred	2013-12-31	$101,719
Benefits paid (including direct rollovers)	2013-12-31	$50,943
Total plan assets at end of year	2013-12-31	$4,790,702
Total plan assets at beginning of year	2013-12-31	$3,686,197
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$126,817
Expenses. Other expenses not covered elsewhere	2013-12-31	$801
Other income received	2013-12-31	$825,702
Net income (gross income less expenses)	2013-12-31	$1,104,505
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$4,790,702
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$3,686,197
Assets. Value of participant loans	2013-12-31	$88,112
Assets. Value of assets in partnership/joint-venture interests	2013-12-31	$75,000
Total contributions received or receivable from employer(s)	2013-12-31	$253,705
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$49,975
2012 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$751,285
Expenses. Total of all expenses incurred	2012-12-31	$80,187
Benefits paid (including direct rollovers)	2012-12-31	$41,844
Total plan assets at end of year	2012-12-31	$3,686,197
Total plan assets at beginning of year	2012-12-31	$3,015,099
Value of fidelity bond covering the plan	2012-12-31	$500,000
Total contributions received or receivable from participants	2012-12-31	$111,496
Expenses. Other expenses not covered elsewhere	2012-12-31	$334
Other income received	2012-12-31	$400,856
Net income (gross income less expenses)	2012-12-31	$671,098
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$3,686,197
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$3,015,099
Assets. Value of participant loans	2012-12-31	$67,086
Assets. Value of assets in partnership/joint-venture interests	2012-12-31	$3,602
Total contributions received or receivable from employer(s)	2012-12-31	$238,933
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$38,009
2011 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$370,259
Expenses. Total of all expenses incurred	2011-12-31	$2,451,215
Benefits paid (including direct rollovers)	2011-12-31	$2,412,763
Total plan assets at end of year	2011-12-31	$3,015,099
Total plan assets at beginning of year	2011-12-31	$5,096,055
Value of fidelity bond covering the plan	2011-12-31	$500,000
Total contributions received or receivable from participants	2011-12-31	$103,828
Expenses. Other expenses not covered elsewhere	2011-12-31	$879
Other income received	2011-12-31	$49,084
Net income (gross income less expenses)	2011-12-31	$-2,080,956
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$3,015,099
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$5,096,055
Assets. Value of participant loans	2011-12-31	$73,474
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$19,890
Total contributions received or receivable from employer(s)	2011-12-31	$217,347
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$37,573
2010 : COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$724,915
Expenses. Total of all expenses incurred	2010-12-31	$3,601,254
Benefits paid (including direct rollovers)	2010-12-31	$3,550,602
Total plan assets at end of year	2010-12-31	$5,096,055
Total plan assets at beginning of year	2010-12-31	$7,972,394
Value of fidelity bond covering the plan	2010-12-31	$500,000
Total contributions received or receivable from participants	2010-12-31	$117,648
Expenses. Other expenses not covered elsewhere	2010-12-31	$874
Other income received	2010-12-31	$395,678
Net income (gross income less expenses)	2010-12-31	$-2,876,339
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$5,096,055
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$7,972,394
Assets. Value of participant loans	2010-12-31	$80,738
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$36,671
Total contributions received or receivable from employer(s)	2010-12-31	$211,589
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$49,778

Form 5500 Responses for COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN

2022: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING 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: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING 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: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING 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: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING 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: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING 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: COLORADO SPRINGS SURGICAL ASSOCIATES, PC PROFIT SHARING 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

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

513064-000

Policy instance

Insurance contract or identification number	513064-000
Number of Individuals Covered	23
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $5
Total amount of fees paid to insurance company	USD $244
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	244
Additional information about fees paid to insurance broker	0
Insurance broker organization code?	5

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

513064-000

Policy instance

Insurance contract or identification number	513064-000
Number of Individuals Covered	19
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $28
Total amount of fees paid to insurance company	USD $223
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	223
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $28

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

513064-000

Policy instance

Insurance contract or identification number	513064-000
Number of Individuals Covered	18
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $19
Total amount of fees paid to insurance company	USD $166
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	166
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $19

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

513064-000

Policy instance

Insurance contract or identification number	513064-000
Number of Individuals Covered	30
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $10
Total amount of fees paid to insurance company	USD $196
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	196
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $10

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

513064-000

Policy instance

Insurance contract or identification number	513064-000
Number of Individuals Covered	20
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $9
Total amount of fees paid to insurance company	USD $750
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	750
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATION
Insurance broker organization code?	5
Commission paid to Insurance Broker	USD $9

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Company Name:	COLORADO SPRINGS SURGICAL ASSOCIATES, PC
Employer identification number (EIN):	840701367
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)