401k Plan data: BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST plan

BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST 401k Plan overview

Plan Name	BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST
Plan identification number	001

BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan covering Self-Employed individuals.
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 REGIONAL EYE INSTITUTE, LLP has sponsored the creation of one or more 401k plans.

Company Name: BLACK HILLS REGIONAL EYE INSTITUTE, LLP

Employer identification number (EIN): 460461540

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

Additional information about BLACK HILLS REGIONAL EYE INSTITUTE, LLP

Jurisdiction of Incorporation: South Dakota Secretary of State

Incorporation Date:

Company Identification Number: DR000563

More information about BLACK HILLS REGIONAL EYE INSTITUTE, LLP

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01 JODI ANDERSON 2024-10-12
001 2022-01-01
001 2021-01-01 JODI ANDERSON 2022-08-01 JODI ANDERSON 2022-08-01
001 2020-01-01 JODI ANDERSON 2021-10-01
001 2019-01-01 JODI ANDERSON 2020-10-07
001 2018-01-01 JODI ANDERSON 2019-08-07
001 2017-01-01 JODI ANDERSON 2018-07-03
001 2016-01-01 JODI ANDERSON 2017-06-02
001 2015-01-01 JODI ANDERSON 2016-07-20
001 2014-01-01 JODI ANDERSON 2015-10-13
001 2014-01-01 JODI ANDERSON 2017-02-27
001 2013-01-01 JODI ANDERSON 2014-06-09
001 2012-01-01 JODI ANDERSON 2013-07-17 JODI ANDERSON 2013-07-17
001 2011-01-01 JODI ANDERSON 2012-07-05 JODI ANDERSON 2012-07-05
001 2010-01-01 JODI ANDERSON 2011-06-10 JODI ANDERSON 2011-06-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2023-01-01	JODI ANDERSON	2024-10-12
001	2022-01-01
001	2021-01-01	JODI ANDERSON	2022-08-01	JODI ANDERSON	2022-08-01
001	2020-01-01	JODI ANDERSON	2021-10-01
001	2019-01-01	JODI ANDERSON	2020-10-07
001	2018-01-01	JODI ANDERSON	2019-08-07
001	2017-01-01	JODI ANDERSON	2018-07-03
001	2016-01-01	JODI ANDERSON	2017-06-02
001	2015-01-01	JODI ANDERSON	2016-07-20
001	2014-01-01	JODI ANDERSON	2015-10-13
001	2014-01-01	JODI ANDERSON	2017-02-27
001	2013-01-01	JODI ANDERSON	2014-06-09
001	2012-01-01	JODI ANDERSON	2013-07-17	JODI ANDERSON	2013-07-17
001	2011-01-01	JODI ANDERSON	2012-07-05	JODI ANDERSON	2012-07-05
001	2010-01-01	JODI ANDERSON	2011-06-10	JODI ANDERSON	2011-06-10

Plan Statistics for BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST

401k plan membership statisitcs for BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST

Measure Date Value
2023: BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST 2023 401k membership
Total participants, beginning-of-year 2023-01-01 167
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 117
Number of retired or separated participants receiving benefits 2023-01-01 3
Number of other retired or separated participants entitled to future benefits 2023-01-01 45
Total of all active and inactive participants 2023-01-01 165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 165
Number of participants with account balances 2023-01-01 136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 8
2022: BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST 2022 401k membership
Total participants, beginning-of-year 2022-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 122
Number of retired or separated participants receiving benefits 2022-01-01 2
Number of other retired or separated participants entitled to future benefits 2022-01-01 35
Total of all active and inactive participants 2022-01-01 159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 159
Number of participants with account balances 2022-01-01 122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 9

Measure	Date	Value
2023: BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST 2023 401k membership
Total participants, beginning-of-year	2023-01-01	167
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	117
Number of retired or separated participants receiving benefits	2023-01-01	3
Number of other retired or separated participants entitled to future benefits	2023-01-01	45
Total of all active and inactive participants	2023-01-01	165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	165
Number of participants with account balances	2023-01-01	136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	8
2022: BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST 2022 401k membership
Total participants, beginning-of-year	2022-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	122
Number of retired or separated participants receiving benefits	2022-01-01	2
Number of other retired or separated participants entitled to future benefits	2022-01-01	35
Total of all active and inactive participants	2022-01-01	159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	159
Number of participants with account balances	2022-01-01	122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	9

Financial Data on BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST

Measure	Date	Value
2023 : BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST 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	$3,310,164
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$628,519
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$594,737
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$1,289,639
Value of total assets at end of year	2023-12-31	$16,202,228
Value of total assets at beginning of year	2023-12-31	$13,520,583
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$33,782
Total interest from all sources	2023-12-31	$6,204
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	$469,290
Participant contributions at end of year	2023-12-31	$117,434
Participant contributions at beginning of year	2023-12-31	$59,619
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$77,562
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	$2,681,645
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$16,202,228
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$13,520,583
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 pooled separate accounts at end of year	2023-12-31	$16,084,794
Value of interest in pooled separate accounts at beginning of year	2023-12-31	$13,460,964
Interest on participant loans	2023-12-31	$6,204
Net investment gain/loss from pooled separate accounts	2023-12-31	$2,014,321
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	$742,787
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$594,737
Contract administrator fees	2023-12-31	$3,031
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 REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST 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	$-845,254
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$1,570,189
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,537,578
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$959,469
Value of total assets at end of year	2022-12-31	$13,520,583
Value of total assets at beginning of year	2022-12-31	$15,936,026
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$32,611
Total interest from all sources	2022-12-31	$2,435
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
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	$378,581
Participant contributions at end of year	2022-12-31	$59,619
Participant contributions at beginning of year	2022-12-31	$42,332
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$34,060
Other income not declared elsewhere	2022-12-31	$1,500
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	$-2,415,443
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$13,520,583
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$15,936,026
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
Investment advisory and management fees	2022-12-31	$29,832
Value of interest in pooled separate accounts at end of year	2022-12-31	$13,460,964
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$15,893,694
Interest on participant loans	2022-12-31	$2,435
Net investment gain/loss from pooled separate accounts	2022-12-31	$-1,808,658
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	Yes
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	$546,828
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$1,537,578
Contract administrator fees	2022-12-31	$2,779
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 T THORSTENSON, LLP
Accountancy firm EIN	2022-12-31	460257538

Form 5500 Responses for BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST

2023: BLACK HILLS REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST 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 REGIONAL EYE INSTITUTE 401(K) PLAN AND TRUST 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
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

Insurance Providers Used on plan

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

086354

Policy instance

Insurance contract or identification number	086354
Number of Individuals Covered	165
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )

Policy contract number

086354

Policy instance

Insurance contract or identification number	086354
Number of Individuals Covered	159
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BLACK HILLS REGIONAL EYE INSTITUTE, LLP
Employer identification number (EIN):	460461540
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	South Dakota Secretary of State
Incorporation Date:
Company Identification Number:	DR000563