401k Plan data: ATHENIX 401(K) PLAN plan

ATHENIX 401(K) PLAN 401k Plan overview

Plan Name	ATHENIX 401(K) PLAN
Plan identification number	001

ATHENIX 401(K) 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

NORTHWEST SURGICAL DEVELOPMENT COMPANY, INC. DBA ATHENIX has sponsored the creation of one or more 401k plans.

Company Name: NORTHWEST SURGICAL DEVELOPMENT COMPANY, INC. DBA ATHENIX

Employer identification number (EIN): 271822053

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ATHENIX 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01 KRISTIN HOUSTON 2022-09-19 KRISTIN HOUSTON 2022-09-19
001 2019-01-01 JAMES HAEFNER 2020-10-15
001 2019-01-01 KRISTIN HOUSTON 2021-08-23 KRISTIN HOUSTON 2021-08-23
001 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01	KRISTIN HOUSTON	2022-09-19	KRISTIN HOUSTON	2022-09-19
001	2019-01-01	JAMES HAEFNER	2020-10-15
001	2019-01-01	KRISTIN HOUSTON	2021-08-23	KRISTIN HOUSTON	2021-08-23
001	2018-01-01
001	2017-01-01
001	2016-01-01
001	2015-01-01

Plan Statistics for ATHENIX 401(K) PLAN

401k plan membership statisitcs for ATHENIX 401(K) PLAN

Measure Date Value
2020: ATHENIX 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 87
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 9
Total of all active and inactive participants 2020-01-01 96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 96
Number of participants with account balances 2020-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: ATHENIX 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 147
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 103
Number of retired or separated participants receiving benefits 2019-01-01 10
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 113
Number of participants with account balances 2019-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0

Measure	Date	Value
2020: ATHENIX 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	87
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	9
Total of all active and inactive participants	2020-01-01	96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	96
Number of participants with account balances	2020-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: ATHENIX 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	147
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	103
Number of retired or separated participants receiving benefits	2019-01-01	10
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	113
Number of participants with account balances	2019-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0

Financial Data on ATHENIX 401(K) PLAN

Measure	Date	Value
2020 : ATHENIX 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$15,348
Total income from all sources (including contributions)	2020-12-31	$234,050
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$19,823
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$7,941
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$109,755
Value of total assets at end of year	2020-12-31	$811,135
Value of total assets at beginning of year	2020-12-31	$612,256
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$11,882
Total interest from all sources	2020-12-31	$317
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Administrative expenses professional fees incurred	2020-12-31	$779
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$109,203
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$0
Assets. Loans (other than to participants) at end of year	2020-12-31	$5,526
Assets. Loans (other than to participants) at beginning of year	2020-12-31	$4,922
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$15,348
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Income. Non cash contributions	2020-12-31	$0
Value of net income/loss	2020-12-31	$214,227
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$811,135
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$596,908
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$3,332
Value of interest in pooled separate accounts at end of year	2020-12-31	$801,942
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$606,398
Income. Interest from loans (other than to participants)	2020-12-31	$317
Value of interest in common/collective trusts at end of year	2020-12-31	$3,115
Value of interest in common/collective trusts at beginning of year	2020-12-31	$936
Net investment gain/loss from pooled separate accounts	2020-12-31	$123,978
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$552
Employer contributions (assets) at end of year	2020-12-31	$552
Employer contributions (assets) at beginning of year	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$7,941
Contract administrator fees	2020-12-31	$7,771
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	HOLTHOUSE CARLIN & VAN TRIGT LLP
Accountancy firm EIN	2020-12-31	954345526
2019 : ATHENIX 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$213,033
Total income from all sources (including contributions)	2019-12-31	$213,033
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$29,431
Total of all expenses incurred	2019-12-31	$29,431
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$19,547
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$19,547
Value of total corrective distributions	2019-12-31	$15,348
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$104,176
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$104,176
Value of total assets at end of year	2019-12-31	$612,256
Value of total assets at end of year	2019-12-31	$612,256
Value of total assets at beginning of year	2019-12-31	$428,654
Value of total assets at beginning of year	2019-12-31	$428,654
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$9,884
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$9,884
Total interest from all sources	2019-12-31	$0
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$115
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$115
Administrative expenses professional fees incurred	2019-12-31	$9,884
Administrative expenses professional fees incurred	2019-12-31	$9,884
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$45,000
Value of fidelity bond cover	2019-12-31	$45,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$104,176
Contributions received from participants	2019-12-31	$104,176
Participant contributions at end of year	2019-12-31	$0
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$3,581
Assets. Loans (other than to participants) at end of year	2019-12-31	$4,922
Assets. Loans (other than to participants) at end of year	2019-12-31	$4,922
Assets. Loans (other than to participants) at beginning of year	2019-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$15,348
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$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	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$183,602
Value of net income/loss	2019-12-31	$183,602
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$612,256
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$612,256
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$428,654
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$428,654
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$607,334
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$607,334
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$425,073
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$425,073
Value of interest in pooled separate accounts at end of year	2019-12-31	$606,398
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$425,073
Value of interest in common/collective trusts at end of year	2019-12-31	$936
Value of interest in common/collective trusts at beginning of year	2019-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$108,742
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$108,742
Net investment gain/loss from pooled separate accounts	2019-12-31	$105,161
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Income. Dividends from preferred stock	2019-12-31	$115
Income. Dividends from preferred stock	2019-12-31	$115
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$19,547
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$19,547
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	HOLTHOUSE CARLIN & VAN TRIGT LLP
Accountancy firm name	2019-12-31	HOLTHOUSE CARLIN & VAN TRIGT LLP
Accountancy firm EIN	2019-12-31	954345526
Accountancy firm EIN	2019-12-31	954345526

Form 5500 Responses for ATHENIX 401(K) PLAN

2020: ATHENIX 401(K) 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 – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: ATHENIX 401(K) 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 – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

118731

Policy instance

Insurance contract or identification number	118731
Number of Individuals Covered	44
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,108
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	1108
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

118731

Policy instance

Insurance contract or identification number	118731
Number of Individuals Covered	47
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $255
Total amount of fees paid to insurance company	USD $650
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
Commission paid to Insurance Broker	USD $255
Amount paid for insurance broker fees	650
Additional information about fees paid to insurance broker	TPA COMP.
Insurance broker organization code?	3

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Company Name:	NORTHWEST SURGICAL DEVELOPMENT COMPANY, INC. DBA ATHENIX
Employer identification number (EIN):	271822053
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)