401k Plan data: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN plan

BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN
Plan identification number	002

BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING 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

BLACK HILLS ORTHOPEDIC AND SPINE CENTER has sponsored the creation of one or more 401k plans.

Company Name: BLACK HILLS ORTHOPEDIC AND SPINE CENTER

Employer identification number (EIN): 460335970

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2023-01-01
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01 TINA WESTON
002 2016-01-01 TINA WESTON
002 2015-01-01 TINA FROELICH
002 2014-09-01 TINA FROELICH
002 2013-09-01 TINA FROELICH 2014-12-09
002 2012-09-01 TINA FROELICH 2013-12-16
002 2011-09-01 PEGGY PALMER 2012-12-11
002 2010-09-01 PEGGY PALMER 2011-10-26 PEGGY PALMER 2011-10-26

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2023-01-01
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01	TINA WESTON
002	2016-01-01	TINA WESTON
002	2015-01-01	TINA FROELICH
002	2014-09-01	TINA FROELICH
002	2013-09-01	TINA FROELICH	2014-12-09
002	2012-09-01	TINA FROELICH	2013-12-16
002	2011-09-01	PEGGY PALMER	2012-12-11
002	2010-09-01	PEGGY PALMER	2011-10-26	PEGGY PALMER	2011-10-26

Plan Statistics for BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN

Measure Date Value
2023: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 211
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 172
Number of retired or separated participants receiving benefits 2023-01-01 2
Number of other retired or separated participants entitled to future benefits 2023-01-01 44
Total of all active and inactive participants 2023-01-01 218
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 218
Number of participants with account balances 2023-01-01 209
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 0
2022: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 199
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 169
Number of retired or separated participants receiving benefits 2022-01-01 4
Number of other retired or separated participants entitled to future benefits 2022-01-01 38
Total of all active and inactive participants 2022-01-01 211
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 211
Number of participants with account balances 2022-01-01 202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 188
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 158
Number of retired or separated participants receiving benefits 2021-01-01 1
Number of other retired or separated participants entitled to future benefits 2021-01-01 40
Total of all active and inactive participants 2021-01-01 199
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 199
Number of participants with account balances 2021-01-01 193
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 174
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 151
Number of retired or separated participants receiving benefits 2020-01-01 2
Number of other retired or separated participants entitled to future benefits 2020-01-01 28
Total of all active and inactive participants 2020-01-01 181
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 181
Number of participants with account balances 2020-01-01 172
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 110
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 30
Total of all active and inactive participants 2019-01-01 141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 141
Number of participants with account balances 2019-01-01 137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 111
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 23
Total of all active and inactive participants 2018-01-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 134
Number of participants with account balances 2018-01-01 134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 112
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 23
Total of all active and inactive participants 2017-01-01 135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 135
Number of participants with account balances 2017-01-01 135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 113
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 23
Total of all active and inactive participants 2016-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 136
Number of participants with account balances 2016-01-01 136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 96
Number of retired or separated participants receiving benefits 2015-01-01 1
Number of other retired or separated participants entitled to future benefits 2015-01-01 25
Total of all active and inactive participants 2015-01-01 122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 122
Number of participants with account balances 2015-01-01 117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-09-01 124
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 97
Number of retired or separated participants receiving benefits 2014-09-01 0
Number of other retired or separated participants entitled to future benefits 2014-09-01 27
Total of all active and inactive participants 2014-09-01 124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-09-01 0
Total participants 2014-09-01 124
Number of participants with account balances 2014-09-01 119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-09-01 0

Measure	Date	Value
2023: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	211
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	172
Number of retired or separated participants receiving benefits	2023-01-01	2
Number of other retired or separated participants entitled to future benefits	2023-01-01	44
Total of all active and inactive participants	2023-01-01	218
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	218
Number of participants with account balances	2023-01-01	209
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	0
2022: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	199
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	169
Number of retired or separated participants receiving benefits	2022-01-01	4
Number of other retired or separated participants entitled to future benefits	2022-01-01	38
Total of all active and inactive participants	2022-01-01	211
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	211
Number of participants with account balances	2022-01-01	202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	188
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	158
Number of retired or separated participants receiving benefits	2021-01-01	1
Number of other retired or separated participants entitled to future benefits	2021-01-01	40
Total of all active and inactive participants	2021-01-01	199
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	199
Number of participants with account balances	2021-01-01	193
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	174
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	151
Number of retired or separated participants receiving benefits	2020-01-01	2
Number of other retired or separated participants entitled to future benefits	2020-01-01	28
Total of all active and inactive participants	2020-01-01	181
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	181
Number of participants with account balances	2020-01-01	172
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	110
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	30
Total of all active and inactive participants	2019-01-01	141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	141
Number of participants with account balances	2019-01-01	137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	111
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	23
Total of all active and inactive participants	2018-01-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	134
Number of participants with account balances	2018-01-01	134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	112
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	23
Total of all active and inactive participants	2017-01-01	135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	135
Number of participants with account balances	2017-01-01	135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	113
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	23
Total of all active and inactive participants	2016-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	136
Number of participants with account balances	2016-01-01	136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	96
Number of retired or separated participants receiving benefits	2015-01-01	1
Number of other retired or separated participants entitled to future benefits	2015-01-01	25
Total of all active and inactive participants	2015-01-01	122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	122
Number of participants with account balances	2015-01-01	117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	124
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	97
Number of retired or separated participants receiving benefits	2014-09-01	0
Number of other retired or separated participants entitled to future benefits	2014-09-01	27
Total of all active and inactive participants	2014-09-01	124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-09-01	0
Total participants	2014-09-01	124
Number of participants with account balances	2014-09-01	119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-09-01	0

Financial Data on BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2023 : BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total income from all sources (including contributions)	2023-12-31	$6,684,510
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$3,935,201
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$3,815,906
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$2,219,114
Value of total assets at end of year	2023-12-31	$29,065,779
Value of total assets at beginning of year	2023-12-31	$26,316,470
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$119,295
Total interest from all sources	2023-12-31	$599,630
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-12-31	No
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$500,000
If this is an individual account plan, was there a blackout period	2023-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-12-31	No
Contributions received from participants	2023-12-31	$971,815
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$8,491
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Value of net income/loss	2023-12-31	$2,749,309
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$29,065,779
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$26,316,470
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-12-31	No
Were any leases to which the plan was party in default or uncollectible	2023-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-12-31	$27,875,712
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-12-31	$25,071,447
Interest earned on other investments	2023-12-31	$599,630
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2023-12-31	$1,190,067
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2023-12-31	$1,245,023
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-12-31	$3,865,766
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-12-31	No
Was there a failure to transmit to the plan any participant contributions	2023-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2023-12-31	No
Contributions received in cash from employer	2023-12-31	$1,238,808
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$3,815,906
Contract administrator fees	2023-12-31	$119,295
Did the plan have assets held for investment	2023-12-31	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	2023-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-12-31	No
Opinion of an independent qualified public accountant for this plan	2023-12-31	Unqualified
Accountancy firm name	2023-12-31	KETEL THORSTENSON, LLP
Accountancy firm EIN	2023-12-31	460257538
2022 : BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-2,845,971
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$2,018,549
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,897,038
Value of total corrective distributions	2022-12-31	$1,168
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$2,202,348
Value of total assets at end of year	2022-12-31	$26,316,470
Value of total assets at beginning of year	2022-12-31	$31,180,990
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$120,343
Total interest from all sources	2022-12-31	$866
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$763,909
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$763,909
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$919,035
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$97,623
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-4,864,520
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$26,316,470
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$31,180,990
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$25,071,447
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$29,467,034
Interest earned on other investments	2022-12-31	$866
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$1,245,023
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$1,713,956
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-5,813,094
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$1,185,690
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$1,897,038
Contract administrator fees	2022-12-31	$120,343
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	KETEL THORSTENSON, LLP
Accountancy firm EIN	2022-12-31	460257538
2021 : BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$7,439,310
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$4,059,110
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$3,916,687
Value of total corrective distributions	2021-12-31	$4,893
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$3,218,732
Value of total assets at end of year	2021-12-31	$31,180,990
Value of total assets at beginning of year	2021-12-31	$27,800,790
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$137,530
Total interest from all sources	2021-12-31	$824
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$737,701
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$737,701
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$965,003
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$1,017,956
Other income not declared elsewhere	2021-12-31	$35,874
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$3,380,200
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$31,180,990
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$27,800,790
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$29,467,034
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$26,138,997
Interest earned on other investments	2021-12-31	$824
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$1,713,956
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$1,661,793
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$3,446,179
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$1,235,773
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$3,916,687
Contract administrator fees	2021-12-31	$137,530
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	KETEL THORSTENSON, LLP
Accountancy firm EIN	2021-12-31	460257538
2020 : BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING 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	$0
Total income from all sources (including contributions)	2020-12-31	$6,312,701
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$986,983
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$880,130
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$2,577,687
Value of total assets at end of year	2020-12-31	$27,800,790
Value of total assets at beginning of year	2020-12-31	$22,475,072
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$106,853
Total interest from all sources	2020-12-31	$15,342
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$552,971
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$552,971
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	$847,793
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$714,136
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
Value of net income/loss	2020-12-31	$5,325,718
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$27,800,790
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$22,475,072
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$26,138,997
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$21,000,465
Interest earned on other investments	2020-12-31	$15,342
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$1,661,793
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$1,474,607
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$3,166,701
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	$1,015,758
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$880,130
Contract administrator fees	2020-12-31	$106,853
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	CASEY PETERSON, LTD
Accountancy firm EIN	2020-12-31	460403496
2019 : BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2019 401k financial data
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 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	$5,738,672
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$1,281,217
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,146,543
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,799,692
Value of total assets at end of year	2019-12-31	$22,475,072
Value of total assets at beginning of year	2019-12-31	$18,017,617
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$134,674
Total interest from all sources	2019-12-31	$46,677
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$452,272
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$452,272
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
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
Contributions received from participants	2019-12-31	$691,708
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$117,807
Other income not declared elsewhere	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
Value of net income/loss	2019-12-31	$4,457,455
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$22,475,072
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$18,017,617
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 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	$21,000,465
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$16,365,960
Interest earned on other investments	2019-12-31	$46,677
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,474,607
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,651,657
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$3,440,031
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
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$990,177
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,146,543
Contract administrator fees	2019-12-31	$134,674
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
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
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	CASEY PETERSON, LTD
Accountancy firm EIN	2019-12-31	460403496
2018 : BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 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	$1,612,109
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$606,819
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$510,633
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,602,255
Value of total assets at end of year	2018-12-31	$18,017,617
Value of total assets at beginning of year	2018-12-31	$17,012,327
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$96,186
Total interest from all sources	2018-12-31	$44,515
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$415,329
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$415,329
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	$696,629
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$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	2018-12-31	No
Value of net income/loss	2018-12-31	$1,005,290
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$18,017,617
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$17,012,327
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	$16,365,960
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$15,269,905
Interest earned on other investments	2018-12-31	$44,515
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$1,651,657
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$1,742,422
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-449,990
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	$905,626
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$510,633
Contract administrator fees	2018-12-31	$96,186
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	CASEY PETERSON, LTD
Accountancy firm EIN	2018-12-31	460403496
2017 : BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 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	$2,998,821
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$2,207,191
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$2,146,441
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,432,513
Value of total assets at end of year	2017-12-31	$17,012,327
Value of total assets at beginning of year	2017-12-31	$16,220,697
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$60,750
Total interest from all sources	2017-12-31	$44,439
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$335,027
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$335,027
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
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	$643,403
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$35,164
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	$791,630
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$17,012,327
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$16,220,697
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	$15,269,905
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$14,306,332
Interest earned on other investments	2017-12-31	$44,439
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$1,742,422
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,914,365
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$1,186,842
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	$753,946
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$2,146,441
Contract administrator fees	2017-12-31	$60,750
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	CASEY PETERSON, LTD
Accountancy firm EIN	2017-12-31	460403496
2016 : BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 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	$2,650,626
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$714,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$708,484
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,492,114
Value of total assets at end of year	2016-12-31	$16,220,697
Value of total assets at beginning of year	2016-12-31	$14,284,778
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$6,223
Total interest from all sources	2016-12-31	$41,660
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$734,921
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$734,921
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
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	$587,744
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$123,587
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	$1,935,919
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$16,220,697
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$14,284,778
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	$14,306,332
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$12,666,116
Interest earned on other investments	2016-12-31	$41,660
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$1,914,365
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$1,618,662
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$381,931
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	No
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	$780,783
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$708,484
Contract administrator fees	2016-12-31	$6,223
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	CASEY PETERSON, LTD
Accountancy firm EIN	2016-12-31	460403496
2015 : BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING 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	$833,438
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$182,271
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$167,996
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$940,706
Value of total assets at end of year	2015-12-31	$14,284,778
Value of total assets at beginning of year	2015-12-31	$13,633,611
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$14,275
Total interest from all sources	2015-12-31	$39,328
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$766,080
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$766,080
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$496,205
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$11,752
Other income not declared elsewhere	2015-12-31	$3,116
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	$651,167
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$14,284,778
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$13,633,611
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$12,666,116
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$12,148,295
Interest earned on other investments	2015-12-31	$39,328
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$1,618,662
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$1,485,316
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-915,792
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
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	$432,749
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$167,996
Contract administrator fees	2015-12-31	$14,275
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	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	CASEY PETERSON & ASSOCIATES, LTD
Accountancy firm EIN	2015-12-31	460403496
2014 : BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$745,142
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$1,415,616
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$1,415,304
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$568,443
Value of total assets at end of year	2014-12-31	$13,633,611
Value of total assets at beginning of year	2014-12-31	$14,304,085
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$312
Total interest from all sources	2014-12-31	$8,230
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$106,246
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$426
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-670,474
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$13,633,611
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$14,304,085
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$12,148,295
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$12,740,177
Interest earned on other investments	2014-12-31	$8,230
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$1,485,316
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$1,563,908
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$168,469
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$461,771
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$1,415,304
Contract administrator fees	2014-12-31	$312
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No

Form 5500 Responses for BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN

2023: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING 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
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING 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
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 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: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 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
2016: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING 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	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: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING 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
2014: BLACK HILLS ORTHOPEDIC AND SPINE CENTER 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	Submission has been amended	No
2014-09-01	This submission is the final filing	No
2014-09-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-09-01	Plan is a collectively bargained plan	No
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan funding arrangement – Trust	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

338861-01

Policy instance

Insurance contract or identification number	338861-01
Number of Individuals Covered	84
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

338861-01

Policy instance

Insurance contract or identification number	338861-01
Number of Individuals Covered	72
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

338861-01

Policy instance

Insurance contract or identification number	338861-01
Number of Individuals Covered	67
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

338861-01

Policy instance

Insurance contract or identification number	338861-01
Number of Individuals Covered	56
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

338861-01

Policy instance

Insurance contract or identification number	338861-01
Number of Individuals Covered	35
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

338861-01

Policy instance

Insurance contract or identification number	338861-01
Number of Individuals Covered	35
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
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?	Yes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

338861-01

Policy instance

Insurance contract or identification number	338861-01
Number of Individuals Covered	42
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
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?	Yes
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
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	MARY SCOTT EHRESMANN

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

338861-01

Policy instance

Insurance contract or identification number	338861-01
Number of Individuals Covered	41
Insurance policy start date	2015-09-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,385
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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?	Yes
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 $2,385
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	MARY SCOTT EHRESMANN

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

338861-01

Policy instance

Insurance contract or identification number	338861-01
Number of Individuals Covered	51
Insurance policy start date	2014-09-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $760
Are there contracts with allocated funds for individual policies?	No
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?	Yes
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	760
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	MARY SCOTT EHRESMANN

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Company Name:	BLACK HILLS ORTHOPEDIC AND SPINE CENTER
Employer identification number (EIN):	460335970
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)