401k Plan data: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST plan

XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST
Plan identification number	001

XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
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.

401k Sponsoring company profile

XELLIA PHARMACEUTICALS USA LLC has sponsored the creation of one or more 401k plans.

Company Name: XELLIA PHARMACEUTICALS USA LLC

Employer identification number (EIN): 830504934

NAIC Classification: 325410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2018-01-01
001 2017-01-01 KATHLEEN ANDERSEN
001 2016-01-01 CAROLYN LOCKHART
001 2016-01-01
001 2015-01-01 CAROLYN LOCKHART
001 2014-01-01 CAROLYN LOCKHART
001 2013-01-01 CAROLYN LOCKHART
001 2012-01-01 CAROLYN LOCKHART

Plan Statistics for XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST

Measure Date Value
2018: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2018 401k membership
Total participants, beginning-of-year 2018-01-01 314
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 342
Number of retired or separated participants receiving benefits 2018-01-01 15
Number of other retired or separated participants entitled to future benefits 2018-01-01 61
Total of all active and inactive participants 2018-01-01 418
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 1
Total participants 2018-01-01 419
Number of participants with account balances 2018-01-01 386
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2017 401k membership
Total participants, beginning-of-year 2017-01-01 246
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 274
Number of retired or separated participants receiving benefits 2017-01-01 10
Number of other retired or separated participants entitled to future benefits 2017-01-01 31
Total of all active and inactive participants 2017-01-01 315
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 315
Number of participants with account balances 2017-01-01 275
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2016 401k membership
Total participants, beginning-of-year 2016-01-01 154
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 224
Number of retired or separated participants receiving benefits 2016-01-01 5
Number of other retired or separated participants entitled to future benefits 2016-01-01 17
Total of all active and inactive participants 2016-01-01 246
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 246
Number of participants with account balances 2016-01-01 213
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year 2015-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 133
Number of retired or separated participants receiving benefits 2015-01-01 3
Number of other retired or separated participants entitled to future benefits 2015-01-01 11
Total of all active and inactive participants 2015-01-01 147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 147
Number of participants with account balances 2015-01-01 133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 107
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 3
Total of all active and inactive participants 2014-01-01 110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 110
Number of participants with account balances 2014-01-01 98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 12
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 1
Total of all active and inactive participants 2013-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 13
Number of participants with account balances 2013-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 9
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 1
Total of all active and inactive participants 2012-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 10
Number of participants with account balances 2012-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0

Measure	Date	Value
2018: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2018 401k membership
Total participants, beginning-of-year	2018-01-01	314
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	342
Number of retired or separated participants receiving benefits	2018-01-01	15
Number of other retired or separated participants entitled to future benefits	2018-01-01	61
Total of all active and inactive participants	2018-01-01	418
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	419
Number of participants with account balances	2018-01-01	386
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2017 401k membership
Total participants, beginning-of-year	2017-01-01	246
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	274
Number of retired or separated participants receiving benefits	2017-01-01	10
Number of other retired or separated participants entitled to future benefits	2017-01-01	31
Total of all active and inactive participants	2017-01-01	315
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	315
Number of participants with account balances	2017-01-01	275
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2016 401k membership
Total participants, beginning-of-year	2016-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	224
Number of retired or separated participants receiving benefits	2016-01-01	5
Number of other retired or separated participants entitled to future benefits	2016-01-01	17
Total of all active and inactive participants	2016-01-01	246
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	246
Number of participants with account balances	2016-01-01	213
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	133
Number of retired or separated participants receiving benefits	2015-01-01	3
Number of other retired or separated participants entitled to future benefits	2015-01-01	11
Total of all active and inactive participants	2015-01-01	147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	147
Number of participants with account balances	2015-01-01	133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	107
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	3
Total of all active and inactive participants	2014-01-01	110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	110
Number of participants with account balances	2014-01-01	98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	12
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	1
Total of all active and inactive participants	2013-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	13
Number of participants with account balances	2013-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	9
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	1
Total of all active and inactive participants	2012-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	10
Number of participants with account balances	2012-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0

Financial Data on XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST

Measure	Date	Value
2018 : XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$2,872,647
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$649,493
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$647,393
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$3,571,257
Value of total assets at end of year	2018-12-31	$8,990,359
Value of total assets at beginning of year	2018-12-31	$6,767,205
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$2,100
Total interest from all sources	2018-12-31	$9,072
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$0
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$1,711,394
Participant contributions at end of year	2018-12-31	$155,862
Participant contributions at beginning of year	2018-12-31	$139,873
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$772,115
Other income not declared elsewhere	2018-12-31	$-707,682
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$2,223,154
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$8,990,359
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$6,767,205
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$8,714,002
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$6,556,874
Value of interest in pooled separate accounts at end of year	2018-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$0
Interest on participant loans	2018-12-31	$8,754
Interest earned on other investments	2018-12-31	$318
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$17,398
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$17,473
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$1,087,748
Employer contributions (assets) at end of year	2018-12-31	$103,097
Employer contributions (assets) at beginning of year	2018-12-31	$52,985
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$647,393
Contract administrator fees	2018-12-31	$2,100
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	ELLIOTT GROUP CPAS, PLLC
Accountancy firm EIN	2018-12-31	454771754
2017 : XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$3,278,052
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$243,152
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$242,345
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$2,390,975
Value of total assets at end of year	2017-12-31	$6,767,205
Value of total assets at beginning of year	2017-12-31	$3,732,305
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$807
Total interest from all sources	2017-12-31	$6,755
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$374,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$1,318,675
Participant contributions at end of year	2017-12-31	$139,873
Participant contributions at beginning of year	2017-12-31	$97,246
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$34
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$320,317
Other income not declared elsewhere	2017-12-31	$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	2017-12-31	No
Value of net income/loss	2017-12-31	$3,034,900
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$6,767,205
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$3,732,305
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$6,556,874
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$3,577,108
Value of interest in pooled separate accounts at end of year	2017-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$0
Interest on participant loans	2017-12-31	$6,559
Income. Interest from loans (other than to participants)	2017-12-31	$0
Interest earned on other investments	2017-12-31	$196
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$17,473
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$10,747
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$880,322
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$751,983
Employer contributions (assets) at end of year	2017-12-31	$52,985
Employer contributions (assets) at beginning of year	2017-12-31	$47,170
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$242,345
Contract administrator fees	2017-12-31	$807
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	ELLIOTT GROUP CPAS, PLLC
Accountancy firm EIN	2017-12-31	454771754
2016 : XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$1,797,915
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$106,169
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$104,879
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,568,668
Value of total assets at end of year	2016-12-31	$3,732,305
Value of total assets at beginning of year	2016-12-31	$2,040,559
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,290
Total interest from all sources	2016-12-31	$6,510
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$265,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$927,009
Participant contributions at end of year	2016-12-31	$97,246
Participant contributions at beginning of year	2016-12-31	$114,034
Participant contributions at end of year	2016-12-31	$34
Participant contributions at beginning of year	2016-12-31	$12,477
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$100,562
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$1,691,746
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$3,732,305
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,040,559
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$3,577,108
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,886,791
Value of interest in pooled separate accounts at end of year	2016-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$0
Interest on participant loans	2016-12-31	$6,020
Interest earned on other investments	2016-12-31	$490
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$10,747
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$20
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$222,737
Net investment gain/loss from pooled separate accounts	2016-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$541,097
Employer contributions (assets) at end of year	2016-12-31	$47,170
Employer contributions (assets) at beginning of year	2016-12-31	$27,237
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$104,879
Contract administrator fees	2016-12-31	$1,290
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	ELLIOTT GROUP CPAS, PLLC
Accountancy firm EIN	2016-12-31	454771754
2015 : XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$1,064,718
Expenses. Total of all expenses incurred	2015-12-31	$44,608
Benefits paid (including direct rollovers)	2015-12-31	$44,608
Total plan assets at end of year	2015-12-31	$2,040,559
Total plan assets at beginning of year	2015-12-31	$1,020,449
Value of fidelity bond covering the plan	2015-12-31	$265,000
Total contributions received or receivable from participants	2015-12-31	$531,779
Contributions received from other sources (not participants or employers)	2015-12-31	$217,013
Other income received	2015-12-31	$-24,022
Net income (gross income less expenses)	2015-12-31	$1,020,110
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$2,040,559
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,020,449
Assets. Value of participant loans	2015-12-31	$114,034
Total contributions received or receivable from employer(s)	2015-12-31	$339,948
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$766,033
Expenses. Total of all expenses incurred	2014-12-31	$5,565
Benefits paid (including direct rollovers)	2014-12-31	$255
Total plan assets at end of year	2014-12-31	$1,020,449
Total plan assets at beginning of year	2014-12-31	$259,981
Value of fidelity bond covering the plan	2014-12-31	$265,000
Total contributions received or receivable from participants	2014-12-31	$214,683
Contributions received from other sources (not participants or employers)	2014-12-31	$395,983
Other income received	2014-12-31	$25,115
Net income (gross income less expenses)	2014-12-31	$760,468
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,020,449
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$259,981
Assets. Value of participant loans	2014-12-31	$25,900
Total contributions received or receivable from employer(s)	2014-12-31	$130,252
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$5,310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$158,647
Expenses. Total of all expenses incurred	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$259,981
Total plan assets at beginning of year	2013-12-31	$101,334
Value of fidelity bond covering the plan	2013-12-31	$265,000
Total contributions received or receivable from participants	2013-12-31	$82,669
Other income received	2013-12-31	$32,119
Net income (gross income less expenses)	2013-12-31	$158,647
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$259,981
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$101,334
Assets. Value of participant loans	2013-12-31	$2,669
Total contributions received or receivable from employer(s)	2013-12-31	$43,859
2012 : XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$0
Total income from all sources	2012-12-31	$101,334
Expenses. Total of all expenses incurred	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$101,334
Total plan assets at beginning of year	2012-12-31	$0
Value of fidelity bond covering the plan	2012-12-31	$265,000
Total contributions received or receivable from participants	2012-12-31	$66,226
Other income received	2012-12-31	$3,478
Net income (gross income less expenses)	2012-12-31	$101,334
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$101,334
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$31,630

Form 5500 Responses for XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST

2018: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 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 – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 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 – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: XELLIA PHARMACEUTICALS, INC. 401(K) PROFIT SHARING PLAN & TRUST 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

E32 6241

Policy instance

Insurance contract or identification number	E32 6241
Number of Individuals Covered	386
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $19,008
Total amount of fees paid to insurance company	USD $0
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?	Yes
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 $17,184
Insurance broker organization code?	7

AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )

Policy contract number

E32 6241

Policy instance

Insurance contract or identification number	E32 6241
Number of Individuals Covered	275
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14,922
Total amount of fees paid to insurance company	USD $0
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?	Yes
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 $14,922
Insurance broker organization code?	7
Insurance broker name	WOODBURY FINANCIAL SERVICES IN

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Company Name:	XELLIA PHARMACEUTICALS USA LLC
Employer identification number (EIN):	830504934
NAIC Classification:	325410

Plan id#	Filing Submission Date	Name of Administrator
001	2018-01-01
001	2017-01-01	KATHLEEN ANDERSEN
001	2016-01-01	CAROLYN LOCKHART
001	2016-01-01
001	2015-01-01	CAROLYN LOCKHART
001	2014-01-01	CAROLYN LOCKHART
001	2013-01-01	CAROLYN LOCKHART
001	2012-01-01	CAROLYN LOCKHART