401k Plan data: MAZOR ROBOTICS, INC. HEALTH AND WELFARE PLAN plan

MAZOR ROBOTICS, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	MAZOR ROBOTICS, INC. HEALTH AND WELFARE PLAN
Plan identification number	501

MAZOR ROBOTICS, INC. HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

MAZOR ROBOTICS INC. has sponsored the creation of one or more 401k plans.

Company Name: MAZOR ROBOTICS INC.

Employer identification number (EIN): 830406611

NAIC Classification: 423400

Additional information about MAZOR ROBOTICS INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2006-04-24

Company Identification Number: 0800645537

Legal Registered Office Address: 710 MEDTRONIC PKWY

MINNEAPOLIS
United States of America (USA)
55432

More information about MAZOR ROBOTICS INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MAZOR ROBOTICS, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01

Plan Statistics for MAZOR ROBOTICS, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for MAZOR ROBOTICS, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2017: MAZOR ROBOTICS, INC. HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 95
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 0
Total of all active and inactive participants 2017-01-01 95

Measure	Date	Value
2017: MAZOR ROBOTICS, INC. HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	95
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	0
Total of all active and inactive participants	2017-01-01	95

Form 5500 Responses for MAZOR ROBOTICS, INC. HEALTH AND WELFARE PLAN

2017: MAZOR ROBOTICS, INC. HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

003U6254

Policy instance

Insurance contract or identification number	003U6254
Number of Individuals Covered	158
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $65,380
Total amount of fees paid to insurance company	USD $1,415
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,307,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $65,380
Amount paid for insurance broker fees	1415
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	BROWN AND BROWN OF FLORIDA, INC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

507759

Policy instance

Insurance contract or identification number	507759
Number of Individuals Covered	83
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14,974
Total amount of fees paid to insurance company	USD $5,079
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $132,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,681
Amount paid for insurance broker fees	5079
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	BROWN AND BROWN OF FLORIDA, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 32395 )

Policy contract number

30054234

Policy instance

Insurance contract or identification number	30054234
Number of Individuals Covered	67
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,272
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,272
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	BROWN AND BROWN OF FLORIDA INC

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Company Name:	MAZOR ROBOTICS INC.
Employer identification number (EIN):	830406611
NAIC Classification:	423400

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2006-04-24
Company Identification Number:	0800645537
Legal Registered Office Address:	710 MEDTRONIC PKWY MINNEAPOLIS United States of America (USA) 55432