401k Plan data: RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN plan

RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN 401k Plan overview

Plan Name	RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN
Plan identification number	001

RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN 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.
Plan not intended to be qualified - A plan not intended to be qualified under Code sections 401, 403, or 408.
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

RIVER OAKS OF MINNESOTA has sponsored the creation of one or more 401k plans.

Company Name: RIVER OAKS OF MINNESOTA

Employer identification number (EIN): 832284893

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01
001 2022-01-01
001 2021-01-01 MICHAEL MADSON 2022-10-17
001 2020-04-15 MICHAEL MADSON 2021-09-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2023-01-01
001	2022-01-01
001	2021-01-01	MICHAEL MADSON	2022-10-17
001	2020-04-15	MICHAEL MADSON	2021-09-20

Plan Statistics for RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN

401k plan membership statisitcs for RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN

Measure Date Value
2023: RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 84
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 17
Total of all active and inactive participants 2023-01-01 101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 1
Total participants 2023-01-01 102
Number of participants with account balances 2023-01-01 100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 75
2022: RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 86
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 33
Total of all active and inactive participants 2022-01-01 119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 119
Number of participants with account balances 2022-01-01 117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 87

Measure	Date	Value
2023: RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	84
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	17
Total of all active and inactive participants	2023-01-01	101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	1
Total participants	2023-01-01	102
Number of participants with account balances	2023-01-01	100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	75
2022: RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	86
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	33
Total of all active and inactive participants	2022-01-01	119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	119
Number of participants with account balances	2022-01-01	117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	87

Financial Data on RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN

Measure	Date	Value
2023 : RIVER OAKS OF MINNESOTA 401(K) RETIREMENT 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	$614,756
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$269,442
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$244,229
Value of total corrective distributions	2023-12-31	$9,033
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$435,377
Value of total assets at end of year	2023-12-31	$1,192,220
Value of total assets at beginning of year	2023-12-31	$846,906
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$16,180
Total interest from all sources	2023-12-31	$1,161
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	$100,000
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	$300,246
Participant contributions at end of year	2023-12-31	$20,550
Participant contributions at beginning of year	2023-12-31	$8,353
Participant contributions at beginning of year	2023-12-31	$10,163
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$1,177
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2023-12-31	$576
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	$345,314
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$1,192,220
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$846,906
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	$1,171,670
Value of interest in pooled separate accounts at beginning of year	2023-12-31	$821,051
Interest on participant loans	2023-12-31	$1,161
Net investment gain/loss from pooled separate accounts	2023-12-31	$178,218
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	No
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	$133,954
Employer contributions (assets) at beginning of year	2023-12-31	$7,339
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$243,653
Contract administrator fees	2023-12-31	$16,180
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	SMITH SCHAFER & ASSOCIATES
Accountancy firm EIN	2023-12-31	411489071
2022 : RIVER OAKS OF MINNESOTA 401(K) RETIREMENT 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	$331,967
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$199,266
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$159,747
Value of total corrective distributions	2022-12-31	$27,641
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$465,712
Value of total assets at end of year	2022-12-31	$846,906
Value of total assets at beginning of year	2022-12-31	$714,205
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$11,878
Total interest from all sources	2022-12-31	$370
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	$100,000
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	$298,696
Participant contributions at end of year	2022-12-31	$8,353
Participant contributions at beginning of year	2022-12-31	$8,147
Participant contributions at end of year	2022-12-31	$10,163
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-12-31	$665
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	$132,701
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$846,906
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$714,205
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 pooled separate accounts at end of year	2022-12-31	$821,051
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$705,992
Interest on participant loans	2022-12-31	$369
Interest earned on other investments	2022-12-31	$1
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$66
Net investment gain/loss from pooled separate accounts	2022-12-31	$-134,115
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	$167,016
Employer contributions (assets) at end of year	2022-12-31	$7,339
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$159,082
Contract administrator fees	2022-12-31	$11,878
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	SMITH, SCHAFER, AND ASSOCIATES, LTD
Accountancy firm EIN	2022-12-31	411489071

Form 5500 Responses for RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN

2023: RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
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: RIVER OAKS OF MINNESOTA 401(K) RETIREMENT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
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

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

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	102
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
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

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

Policy contract number

724435

Policy instance

Insurance contract or identification number	724435
Number of Individuals Covered	102
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $4,528
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	119
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
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
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
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

724435

Policy instance

Insurance contract or identification number	724435
Number of Individuals Covered	119
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,377
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	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 $3,377
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	RIVER OAKS OF MINNESOTA
Employer identification number (EIN):	832284893
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities