401k Plan data: EMPI, INC. 401(K) PROFIT SHARING PLAN plan

EMPI, INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	EMPI, INC. 401(K) PROFIT SHARING PLAN
Plan identification number	003

EMPI, INC. 401(K) PROFIT SHARING PLAN 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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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

EMPI, INC. has sponsored the creation of one or more 401k plans.

Company Name: EMPI, INC.

Employer identification number (EIN): 953240201

NAIC Classification: 423100

Additional information about EMPI, INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 4275514

More information about EMPI, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPI, INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2017-01-01 TAMARA MINARSCH
003 2016-01-01 TAMARA MINARSCH 2017-06-28 TAMARA MINARSCH 2017-06-28
003 2015-01-01 TAMARA MINARSCH 2016-07-12 TAMARA MINARSCH 2016-07-12
003 2014-01-01 TAMARA MINARSCH 2015-07-30 TAMARA MINARSCH 2015-07-30
003 2013-01-01 TAMARA MINARSCH 2014-07-16 TAMARA MINARSCH 2014-07-16
003 2012-01-01 TAMARA MINARSCH 2013-06-19 TAMARA MINARSCH 2013-06-19
003 2011-01-01 TAMARA MINARSCH 2012-06-06 TAMARA MINARSCH 2012-06-06
003 2010-01-01 TAMARA MINARSCH 2011-05-18 TAMARA MINARSCH 2011-05-18
003 2009-01-01 TAMARA MINARSCH
003 2009-01-01 TAMARA MINARSCH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2017-01-01	TAMARA MINARSCH
003	2016-01-01	TAMARA MINARSCH	2017-06-28	TAMARA MINARSCH	2017-06-28
003	2015-01-01	TAMARA MINARSCH	2016-07-12	TAMARA MINARSCH	2016-07-12
003	2014-01-01	TAMARA MINARSCH	2015-07-30	TAMARA MINARSCH	2015-07-30
003	2013-01-01	TAMARA MINARSCH	2014-07-16	TAMARA MINARSCH	2014-07-16
003	2012-01-01	TAMARA MINARSCH	2013-06-19	TAMARA MINARSCH	2013-06-19
003	2011-01-01	TAMARA MINARSCH	2012-06-06	TAMARA MINARSCH	2012-06-06
003	2010-01-01	TAMARA MINARSCH	2011-05-18	TAMARA MINARSCH	2011-05-18
003	2009-01-01	TAMARA MINARSCH
003	2009-01-01	TAMARA MINARSCH

Plan Statistics for EMPI, INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for EMPI, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2017: EMPI, INC. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 44
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 62
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 6
Total of all active and inactive participants 2017-01-01 68
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 68
Number of participants with account balances 2017-01-01 53
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2009: EMPI, INC. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 75
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 68
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 8
Total of all active and inactive participants 2009-01-01 76
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 76
Number of participants with account balances 2009-01-01 62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2017: EMPI, INC. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	44
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	62
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	6
Total of all active and inactive participants	2017-01-01	68
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	68
Number of participants with account balances	2017-01-01	53
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2009: EMPI, INC. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	75
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	68
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	8
Total of all active and inactive participants	2009-01-01	76
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	76
Number of participants with account balances	2009-01-01	62
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on EMPI, INC. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2017 : EMPI, INC. 401(K) PROFIT SHARING PLAN 2017 401k financial data
Transfers to/from the plan	2017-12-31	$0
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$869,356
Expenses. Total of all expenses incurred	2017-12-31	$13,947
Benefits paid (including direct rollovers)	2017-12-31	$13,447
Total plan assets at end of year	2017-12-31	$4,846,757
Total plan assets at beginning of year	2017-12-31	$3,991,348
Value of fidelity bond covering the plan	2017-12-31	$484,676
Total contributions received or receivable from participants	2017-12-31	$228,810
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$2,196
Other income received	2017-12-31	$529,008
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$855,409
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$4,846,757
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$3,991,348
Assets. Value of participant loans	2017-12-31	$29,144
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2017-12-31	$0
Total contributions received or receivable from employer(s)	2017-12-31	$109,342
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$500

Form 5500 Responses for EMPI, INC. 401(K) PROFIT SHARING PLAN

2017: EMPI, INC. 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – 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
2009: EMPI, INC. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )

Policy contract number

040830

Policy instance

Insurance contract or identification number	040830
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-09-29
Total amount of commissions paid to insurance broker	USD $0
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?	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 $0
Amount paid for insurance broker fees	0
Insurance broker name

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Company Name:	EMPI, INC.
Employer identification number (EIN):	953240201
NAIC Classification:	423100

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	4275514