401k Plan data: PROFIT SHARING PLAN plan

PROFIT SHARING PLAN 401k Plan overview

Plan Name	PROFIT SHARING PLAN
Plan identification number	001

PROFIT SHARING PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Profit-sharing

401k Sponsoring company profile

PACIFIC RIDGE MEDICAL, INC. has sponsored the creation of one or more 401k plans.

Company Name: PACIFIC RIDGE MEDICAL, INC.

Employer identification number (EIN): 912181710

NAIC Classification: 454390
NAIC Description: Other Direct Selling Establishments

Additional information about PACIFIC RIDGE MEDICAL, INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division

Incorporation Date: 2003-01-09

Company Identification Number: 602261518

Legal Registered Office Address: 3624 46TH AVE SW

SEATTLE
United States of America (USA)
981163722

More information about PACIFIC RIDGE MEDICAL, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2013-01-01 DALE KNEZEVICH
001 2012-01-01 DALE KNEZEVICH
001 2011-01-01 DALE KNEZEVICH

Plan id#	Filing Submission Date	Name of Administrator
001	2013-01-01	DALE KNEZEVICH
001	2012-01-01	DALE KNEZEVICH
001	2011-01-01	DALE KNEZEVICH

Plan Statistics for PROFIT SHARING PLAN

401k plan membership statisitcs for PROFIT SHARING PLAN

Measure Date Value
2013: PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 0
Number of participants with account balances 2013-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 2
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2
Total of all active and inactive participants 2012-01-01 2
Total participants 2012-01-01 2
Number of participants with account balances 2012-01-01 2
2011: PROFIT SHARING 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 2
Number of retired or separated participants receiving benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 2
Total participants 2011-01-01 2
Number of participants with account balances 2011-01-01 2

Measure	Date	Value
2013: PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	0
Number of participants with account balances	2013-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	2
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2
Total of all active and inactive participants	2012-01-01	2
Total participants	2012-01-01	2
Number of participants with account balances	2012-01-01	2
2011: PROFIT SHARING 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	2
Number of retired or separated participants receiving benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	2
Total participants	2011-01-01	2
Number of participants with account balances	2011-01-01	2

Financial Data on PROFIT SHARING PLAN

Measure	Date	Value
2013 : PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan	2013-03-15	$0
Total plan liabilities at beginning of year	2013-03-15	$0
Total income from all sources	2013-03-15	$137,081
Expenses. Total of all expenses incurred	2013-03-15	$1,661,300
Benefits paid (including direct rollovers)	2013-03-15	$1,657,863
Total plan assets at end of year	2013-03-15	$0
Total plan assets at beginning of year	2013-03-15	$1,524,219
Total contributions received or receivable from participants	2013-03-15	$0
Expenses. Other expenses not covered elsewhere	2013-03-15	$0
Contributions received from other sources (not participants or employers)	2013-03-15	$0
Other income received	2013-03-15	$137,081
Noncash contributions received	2013-03-15	$0
Net income (gross income less expenses)	2013-03-15	$-1,524,219
Net plan assets at end of year (total assets less liabilities)	2013-03-15	$0
Net plan assets at beginning of year (total assets less liabilities)	2013-03-15	$1,524,219
Total contributions received or receivable from employer(s)	2013-03-15	$0
Value of certain deemed distributions of participant loans	2013-03-15	$0
Value of corrective distributions	2013-03-15	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-03-15	$3,437
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2013-03-15	50000
2012 : PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$252,022
Expenses. Total of all expenses incurred	2012-12-31	$62,807
Benefits paid (including direct rollovers)	2012-12-31	$50,000
Total plan assets at end of year	2012-12-31	$1,524,219
Total plan assets at beginning of year	2012-12-31	$1,335,004
Expenses. Other expenses not covered elsewhere	2012-12-31	$12,807
Other income received	2012-12-31	$252,022
Net income (gross income less expenses)	2012-12-31	$189,215
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,524,219
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,335,004
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2012-12-31	50000
2011 : PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$-142,569
Expenses. Total of all expenses incurred	2011-12-31	$50,000
Benefits paid (including direct rollovers)	2011-12-31	$50,000
Total plan assets at end of year	2011-12-31	$1,335,004
Total plan assets at beginning of year	2011-12-31	$1,527,573
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Other income received	2011-12-31	$-142,569
Net income (gross income less expenses)	2011-12-31	$-192,569
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,335,004
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,527,573
Total contributions received or receivable from employer(s)	2011-12-31	$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2011-12-31	50000
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$-77,979
Expenses. Total of all expenses incurred	2010-12-31	$50,000
Benefits paid (including direct rollovers)	2010-12-31	$50,000
Total plan assets at end of year	2010-12-31	$1,527,573
Total plan assets at beginning of year	2010-12-31	$1,655,552
Total contributions received or receivable from participants	2010-12-31	$0
Other income received	2010-12-31	$-77,979
Net income (gross income less expenses)	2010-12-31	$-127,979
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,527,573
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,655,552
Total contributions received or receivable from employer(s)	2010-12-31	$0

Form 5500 Responses for PROFIT SHARING PLAN

2013: PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	Yes
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	PACIFIC RIDGE MEDICAL, INC.
Employer identification number (EIN):	912181710
NAIC Classification:	454390
NAIC Description:	Other Direct Selling Establishments

Jurisdiction of Incorporation:	Washington Secretary of State Corporations Division
Incorporation Date:	2003-01-09
Company Identification Number:	602261518
Legal Registered Office Address:	3624 46TH AVE SW SEATTLE United States of America (USA) 981163722