401k Plan data: ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN plan

ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 401k Plan overview

Plan Name	ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN
Plan identification number	009

ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Cash balance or similar plan - Plan has a "cash balance" formula. For this purpose, a "cash balance" formula is a benefit formula in a defined benefit plan by whatever name (for example, personal account plan, pension equity plan, life cycle plan, cash account plan, etc.) that rather than, or in addition to, expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee in terms more common to a defined contribution plan such as a single sum distribution amount (for example, 10 percent of final average pay times years of service, or the amount of the employee's hypothetical account balance).
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

INFINITE HEALTH COLLABORATIVE, P.A. has sponsored the creation of one or more 401k plans.

Company Name: INFINITE HEALTH COLLABORATIVE, P.A.

Employer identification number (EIN): 411861374

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
009 2016-01-01 JAY HEMPE JAY HEMPE 2017-09-14
009 2015-01-01 JAY HEMPE JAY HEMPE 2016-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
009	2016-01-01	JAY HEMPE		JAY HEMPE	2017-09-14
009	2015-01-01	JAY HEMPE		JAY HEMPE	2016-10-14

Plan Statistics for ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN

401k plan membership statisitcs for ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN

Measure Date Value
2016: ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 159
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 147
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 14
Total of all active and inactive participants 2015-01-01 161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0

Measure	Date	Value
2016: ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	159
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	147
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	14
Total of all active and inactive participants	2015-01-01	161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0

Financial Data on ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN

Measure	Date	Value
2016 : ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 2016 401k financial data
Total income from all sources (including contributions)	2016-11-17	$106,083
Total of all expenses incurred	2016-11-17	$1,703,072
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-11-17	$1,697,741
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-11-17	$14,936
Value of total assets at end of year	2016-11-17	$0
Value of total assets at beginning of year	2016-11-17	$1,596,989
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-11-17	$5,331
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-11-17	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2016-11-17	$0
Was this plan covered by a fidelity bond	2016-11-17	Yes
Value of fidelity bond cover	2016-11-17	$50,000
Were there any nonexempt tranactions with any party-in-interest	2016-11-17	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	2016-11-17	No
Value of net income/loss	2016-11-17	$-1,596,989
Value of net assets at end of year (total assets less liabilities)	2016-11-17	$0
Value of net assets at beginning of year (total assets less liabilities)	2016-11-17	$1,596,989
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-11-17	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-11-17	No
Were any leases to which the plan was party in default or uncollectible	2016-11-17	No
Value of interest in pooled separate accounts at end of year	2016-11-17	$0
Value of interest in pooled separate accounts at beginning of year	2016-11-17	$1,596,989
Net investment gain/loss from pooled separate accounts	2016-11-17	$91,147
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-11-17	No
Was there a failure to transmit to the plan any participant contributions	2016-11-17	No
Has the plan failed to provide any benefit when due under the plan	2016-11-17	No
Contributions received in cash from employer	2016-11-17	$14,936
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-11-17	$1,697,741
Contract administrator fees	2016-11-17	$5,331
Did the plan have assets held for investment	2016-11-17	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	2016-11-17	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-11-17	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-11-17	No
Opinion of an independent qualified public accountant for this plan	2016-11-17	Unqualified
Accountancy firm name	2016-11-17	DS&B, LTD.
Accountancy firm EIN	2016-11-17	411475695
2015 : ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$785,070
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$10,723
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$3,388
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$800,000
Value of total assets at end of year	2015-12-31	$1,596,989
Value of total assets at beginning of year	2015-12-31	$822,642
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$7,335
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-12-31	$0
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$0
Administrative expenses (other) incurred	2015-12-31	$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	2015-12-31	No
Value of net income/loss	2015-12-31	$774,347
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,596,989
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$822,642
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Investment advisory and management fees	2015-12-31	$0
Value of interest in pooled separate accounts at end of year	2015-12-31	$1,596,989
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$822,642
Net investment gain/loss from pooled separate accounts	2015-12-31	$-14,930
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$800,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$3,388
Contract administrator fees	2015-12-31	$7,335
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	DS&B, LTD.
Accountancy firm EIN	2015-12-31	411475695

Form 5500 Responses for ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN

2016: ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
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: ST. CROIX ORTHOPAEDICS, P.A. CASH BALANCE PLAN 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 – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

461245

Policy instance

Insurance contract or identification number	461245
Number of Individuals Covered	156
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,529
Total amount of fees paid to insurance company	USD $510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,529
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker name	TAX SHELTERED COMPENSATION INC

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Company Name:	INFINITE HEALTH COLLABORATIVE, P.A.
Employer identification number (EIN):	411861374
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)