401k Plan data: 401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC. plan

401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC. 401k Plan overview

Plan Name	401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC.
Plan identification number	002

401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC. Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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.

401k Sponsoring company profile

MINNESOTA INDIAN PRIMARY RESIDENTIAL has sponsored the creation of one or more 401k plans.

Company Name: MINNESOTA INDIAN PRIMARY RESIDENTIAL

Employer identification number (EIN): 411299061

NAIC Classification: 621420
NAIC Description: Outpatient Mental Health and Substance Abuse Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2021-01-01 SANDRA MILLER 2022-03-24
002 2021-01-01 JAMES MALLERY 2022-05-02
002 2020-01-01 SANDRA MILLER 2021-08-17
002 2019-01-01
002 2018-01-01 JAMES W. MALLERY II 2019-09-09
002 2017-01-01 JAMES W. MALLERY II 2018-09-25
002 2016-01-01 JAMES W. MALLERY II 2017-08-10
002 2015-01-01 MASHKAWISEN8 2016-06-28
002 2014-01-01 JAMES MALLERY 2015-08-12
002 2013-01-01 JAMES MALLERY 2014-05-14
002 2012-01-01 JAMES MALLERY 2013-02-19
002 2011-01-01 JAMES MALLERY 2012-02-24
002 2010-01-01 JAMES MALLERY 2011-07-13 JAMES MALLERY 2011-07-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2021-01-01	SANDRA MILLER	2022-03-24
002	2021-01-01	JAMES MALLERY	2022-05-02
002	2020-01-01	SANDRA MILLER	2021-08-17
002	2019-01-01
002	2018-01-01	JAMES W. MALLERY II	2019-09-09
002	2017-01-01	JAMES W. MALLERY II	2018-09-25
002	2016-01-01	JAMES W. MALLERY II	2017-08-10
002	2015-01-01	MASHKAWISEN8	2016-06-28
002	2014-01-01	JAMES MALLERY	2015-08-12
002	2013-01-01	JAMES MALLERY	2014-05-14
002	2012-01-01	JAMES MALLERY	2013-02-19
002	2011-01-01	JAMES MALLERY	2012-02-24
002	2010-01-01	JAMES MALLERY	2011-07-13	JAMES MALLERY	2011-07-13

Plan Statistics for 401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC.

401k plan membership statisitcs for 401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC.

Measure Date Value
2019: 401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC. 2019 401k membership
Total participants, beginning-of-year 2019-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 71
Number of retired or separated participants receiving benefits 2019-01-01 2
Number of other retired or separated participants entitled to future benefits 2019-01-01 5
Total of all active and inactive participants 2019-01-01 78
Total participants 2019-01-01 78
Number of participants with account balances 2019-01-01 77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0

Measure	Date	Value
2019: 401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC. 2019 401k membership
Total participants, beginning-of-year	2019-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	71
Number of retired or separated participants receiving benefits	2019-01-01	2
Number of other retired or separated participants entitled to future benefits	2019-01-01	5
Total of all active and inactive participants	2019-01-01	78
Total participants	2019-01-01	78
Number of participants with account balances	2019-01-01	77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0

Financial Data on 401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC.

Measure	Date	Value
2019 : 401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC. 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$553,500
Total income from all sources (including contributions)	2019-12-31	$553,500
Total of all expenses incurred	2019-12-31	$635,802
Total of all expenses incurred	2019-12-31	$635,802
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$623,542
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$623,542
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$262,636
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$262,636
Value of total assets at end of year	2019-12-31	$1,791,979
Value of total assets at end of year	2019-12-31	$1,791,979
Value of total assets at beginning of year	2019-12-31	$1,874,281
Value of total assets at beginning of year	2019-12-31	$1,874,281
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$12,260
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$12,260
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$300,000
Value of fidelity bond cover	2019-12-31	$300,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$153,649
Contributions received from participants	2019-12-31	$153,649
Participant contributions at end of year	2019-12-31	$2,385
Participant contributions at end of year	2019-12-31	$2,385
Participant contributions at beginning of year	2019-12-31	$2,385
Participant contributions at beginning of year	2019-12-31	$2,385
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
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	$-82,302
Value of net income/loss	2019-12-31	$-82,302
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,791,979
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,791,979
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,874,281
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,874,281
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
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 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
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in pooled separate accounts at end of year	2019-12-31	$1,539,429
Value of interest in pooled separate accounts at end of year	2019-12-31	$1,539,429
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$1,584,398
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$1,584,398
Value of interest in common/collective trusts at end of year	2019-12-31	$250,165
Value of interest in common/collective trusts at end of year	2019-12-31	$250,165
Value of interest in common/collective trusts at beginning of year	2019-12-31	$287,498
Value of interest in common/collective trusts at beginning of year	2019-12-31	$287,498
Net investment gain/loss from pooled separate accounts	2019-12-31	$288,382
Net investment gain/loss from pooled separate accounts	2019-12-31	$288,382
Net investment gain or loss from common/collective trusts	2019-12-31	$2,482
Net investment gain or loss from common/collective trusts	2019-12-31	$2,482
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
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
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
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	$108,987
Contributions received in cash from employer	2019-12-31	$108,987
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$623,542
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$623,542
Contract administrator fees	2019-12-31	$12,260
Contract administrator fees	2019-12-31	$12,260
Did the plan have assets held for investment	2019-12-31	Yes
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
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
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
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
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	RSM US LLP
Accountancy firm name	2019-12-31	RSM US LLP
Accountancy firm EIN	2019-12-31	420714325
Accountancy firm EIN	2019-12-31	420714325

Form 5500 Responses for 401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC.

2019: 401(K) PLAN FOR EMPLOYEES OF MINNESOTA INDIAN PRIMARY RESIDENTIAL TREATMENT CENTER, INC. 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
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

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

806358-000

Policy instance

Insurance contract or identification number	806358-000
Number of Individuals Covered	100
Total amount of fees paid to insurance company	USD $357
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	357
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5

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Company Name:	MINNESOTA INDIAN PRIMARY RESIDENTIAL
Employer identification number (EIN):	411299061
NAIC Classification:	621420
NAIC Description:	Outpatient Mental Health and Substance Abuse Centers