401k Plan data: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN plan

COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 401k Plan overview

Plan Name	COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN
Plan identification number	002

COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN Benefits

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

401k Sponsoring company profile

COLUMBIA ORTHOPAEDIC CLINIC, PS has sponsored the creation of one or more 401k plans.

Company Name: COLUMBIA ORTHOPAEDIC CLINIC, PS

Employer identification number (EIN): 911009113

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2015-09-01 CHARLES LARSON 2016-07-14 CHARLES LARSON 2016-07-14
002 2014-09-01 CHARLES LARSON 2015-10-06 CHARLES LARSON 2015-10-06
002 2013-09-01 CHARLES LARSON 2014-11-11 CHARLES LARSON 2014-11-11
002 2012-09-01 CHARLES LARSON 2013-11-26 CHARLES LARSON 2013-11-26
002 2011-09-01 CHARLES LARSON 2012-10-02 CHARLES LARSON 2012-10-02

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2015-09-01	CHARLES LARSON	2016-07-14	CHARLES LARSON	2016-07-14
002	2014-09-01	CHARLES LARSON	2015-10-06	CHARLES LARSON	2015-10-06
002	2013-09-01	CHARLES LARSON	2014-11-11	CHARLES LARSON	2014-11-11
002	2012-09-01	CHARLES LARSON	2013-11-26	CHARLES LARSON	2013-11-26
002	2011-09-01	CHARLES LARSON	2012-10-02	CHARLES LARSON	2012-10-02

Plan Statistics for COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN

401k plan membership statisitcs for COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN

Measure Date Value
2015: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-09-01 1
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 0
Number of retired or separated participants receiving benefits 2015-09-01 0
Number of other retired or separated participants entitled to future benefits 2015-09-01 0
Total of all active and inactive participants 2015-09-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-09-01 0
Total participants 2015-09-01 0
Number of participants with account balances 2015-09-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-09-01 0
2014: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-09-01 1
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 1
Number of retired or separated participants receiving benefits 2014-09-01 0
Number of other retired or separated participants entitled to future benefits 2014-09-01 0
Total of all active and inactive participants 2014-09-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-09-01 0
Total participants 2014-09-01 1
Number of participants with account balances 2014-09-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-09-01 0
2013: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2013 401k membership
Total participants, beginning-of-year 2013-09-01 1
Total number of active participants reported on line 7a of the Form 5500 2013-09-01 1
Number of retired or separated participants receiving benefits 2013-09-01 0
Number of other retired or separated participants entitled to future benefits 2013-09-01 0
Total of all active and inactive participants 2013-09-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-09-01 0
Total participants 2013-09-01 1
Number of participants with account balances 2013-09-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-09-01 0
2012: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 1
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 1
Number of retired or separated participants receiving benefits 2012-09-01 0
Number of other retired or separated participants entitled to future benefits 2012-09-01 0
Total of all active and inactive participants 2012-09-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-09-01 0
Total participants 2012-09-01 1
Number of participants with account balances 2012-09-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-09-01 0
2011: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 1
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 1
Number of retired or separated participants receiving benefits 2011-09-01 0
Number of other retired or separated participants entitled to future benefits 2011-09-01 0
Total of all active and inactive participants 2011-09-01 1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-09-01 0
Total participants 2011-09-01 1
Number of participants with account balances 2011-09-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-09-01 0

Measure	Date	Value
2015: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	1
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	0
Number of retired or separated participants receiving benefits	2015-09-01	0
Number of other retired or separated participants entitled to future benefits	2015-09-01	0
Total of all active and inactive participants	2015-09-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-09-01	0
Total participants	2015-09-01	0
Number of participants with account balances	2015-09-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-09-01	0
2014: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	1
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	1
Number of retired or separated participants receiving benefits	2014-09-01	0
Number of other retired or separated participants entitled to future benefits	2014-09-01	0
Total of all active and inactive participants	2014-09-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-09-01	0
Total participants	2014-09-01	1
Number of participants with account balances	2014-09-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-09-01	0
2013: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-09-01	1
Total number of active participants reported on line 7a of the Form 5500	2013-09-01	1
Number of retired or separated participants receiving benefits	2013-09-01	0
Number of other retired or separated participants entitled to future benefits	2013-09-01	0
Total of all active and inactive participants	2013-09-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-09-01	0
Total participants	2013-09-01	1
Number of participants with account balances	2013-09-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-09-01	0
2012: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	1
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	1
Number of retired or separated participants receiving benefits	2012-09-01	0
Number of other retired or separated participants entitled to future benefits	2012-09-01	0
Total of all active and inactive participants	2012-09-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-09-01	0
Total participants	2012-09-01	1
Number of participants with account balances	2012-09-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-09-01	0
2011: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	1
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	1
Number of retired or separated participants receiving benefits	2011-09-01	0
Number of other retired or separated participants entitled to future benefits	2011-09-01	0
Total of all active and inactive participants	2011-09-01	1
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-09-01	0
Total participants	2011-09-01	1
Number of participants with account balances	2011-09-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-09-01	0

Financial Data on COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN

Measure	Date	Value
2016 : COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2016 401k financial data
Total income from all sources	2016-06-30	$5,545
Expenses. Total of all expenses incurred	2016-06-30	$1,107,247
Benefits paid (including direct rollovers)	2016-06-30	$1,107,226
Total plan assets at end of year	2016-06-30	$0
Total plan assets at beginning of year	2016-06-30	$1,101,702
Expenses. Other expenses not covered elsewhere	2016-06-30	$21
Other income received	2016-06-30	$5,545
Net income (gross income less expenses)	2016-06-30	$-1,101,702
Net plan assets at end of year (total assets less liabilities)	2016-06-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2016-06-30	$1,101,702
2015 : COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2015 401k financial data
Total income from all sources	2015-08-31	$-32,966
Expenses. Total of all expenses incurred	2015-08-31	$85
Total plan assets at end of year	2015-08-31	$1,101,702
Total plan assets at beginning of year	2015-08-31	$1,134,753
Expenses. Other expenses not covered elsewhere	2015-08-31	$85
Other income received	2015-08-31	$-32,966
Net income (gross income less expenses)	2015-08-31	$-33,051
Net plan assets at end of year (total assets less liabilities)	2015-08-31	$1,101,702
Net plan assets at beginning of year (total assets less liabilities)	2015-08-31	$1,134,753
2014 : COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2014 401k financial data
Total income from all sources	2014-08-31	$185,626
Expenses. Total of all expenses incurred	2014-08-31	$82
Total plan assets at end of year	2014-08-31	$1,134,753
Total plan assets at beginning of year	2014-08-31	$949,209
Expenses. Other expenses not covered elsewhere	2014-08-31	$82
Other income received	2014-08-31	$185,626
Net income (gross income less expenses)	2014-08-31	$185,544
Net plan assets at end of year (total assets less liabilities)	2014-08-31	$1,134,753
Net plan assets at beginning of year (total assets less liabilities)	2014-08-31	$949,209
2013 : COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2013 401k financial data
Total income from all sources	2013-08-31	$78,347
Expenses. Total of all expenses incurred	2013-08-31	$78
Total plan assets at end of year	2013-08-31	$949,209
Total plan assets at beginning of year	2013-08-31	$870,940
Expenses. Other expenses not covered elsewhere	2013-08-31	$78
Other income received	2013-08-31	$78,347
Net income (gross income less expenses)	2013-08-31	$78,269
Net plan assets at end of year (total assets less liabilities)	2013-08-31	$949,209
Net plan assets at beginning of year (total assets less liabilities)	2013-08-31	$870,940
2012 : COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2012 401k financial data
Total income from all sources	2012-08-31	$121,248
Total plan assets at end of year	2012-08-31	$870,940
Total plan assets at beginning of year	2012-08-31	$749,692
Other income received	2012-08-31	$121,248
Net income (gross income less expenses)	2012-08-31	$121,248
Net plan assets at end of year (total assets less liabilities)	2012-08-31	$870,940
Net plan assets at beginning of year (total assets less liabilities)	2012-08-31	$749,692
2011 : COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2011 401k financial data
Total income from all sources	2011-08-31	$53,957
Total plan assets at end of year	2011-08-31	$749,692
Total plan assets at beginning of year	2011-08-31	$695,735
Other income received	2011-08-31	$53,957
Net income (gross income less expenses)	2011-08-31	$53,957
Net plan assets at end of year (total assets less liabilities)	2011-08-31	$749,692
Net plan assets at beginning of year (total assets less liabilities)	2011-08-31	$695,735

Form 5500 Responses for COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN

2015: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	This submission is the final filing	Yes
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-09-01	Plan funding arrangement – Trust	Yes
2015-09-01	Plan benefit arrangement - Trust	Yes
2014: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Plan funding arrangement – Trust	Yes
2014-09-01	Plan benefit arrangement - Trust	Yes
2013: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2013 form 5500 responses
2013-09-01	Type of plan entity	Single employer plan
2013-09-01	Plan funding arrangement – Trust	Yes
2013-09-01	Plan benefit arrangement - Trust	Yes
2012: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Plan funding arrangement – Trust	Yes
2012-09-01	Plan benefit arrangement - Trust	Yes
2011: COLUMBIA ORTHOPAEDIC CLINIC PS MONEY PURCHASE PENSION PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	Submission has been amended	Yes
2011-09-01	Plan funding arrangement – Trust	Yes
2011-09-01	Plan benefit arrangement - Trust	Yes

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Company Name:	COLUMBIA ORTHOPAEDIC CLINIC, PS
Employer identification number (EIN):	911009113
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)