401k Plan data: OUR HOMES SOUTH, INC. 401(K) PLAN plan

OUR HOMES SOUTH, INC. 401(K) PLAN 401k Plan overview

Plan Name	OUR HOMES SOUTH, INC. 401(K) PLAN
Plan identification number	001

OUR HOMES SOUTH, INC. 401(K) 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.
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

OUR HOMES SOUTH, INC. has sponsored the creation of one or more 401k plans.

Company Name: OUR HOMES SOUTH, INC.

Employer identification number (EIN): 411759791

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OUR HOMES SOUTH, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 BELINDA ISAACSON 2023-07-10
001 2021-01-01
001 2020-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 DENNIS BURGESS DENNIS BURGESS 2019-07-24
001 2017-01-01 DENNIS BURGESS
001 2016-01-01 DENNIS BURGESS

Plan Statistics for OUR HOMES SOUTH, INC. 401(K) PLAN

401k plan membership statisitcs for OUR HOMES SOUTH, INC. 401(K) PLAN

Measure Date Value
2021: OUR HOMES SOUTH, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 78
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 14
Total of all active and inactive participants 2021-01-01 92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 93
Number of participants with account balances 2021-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: OUR HOMES SOUTH, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 84
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 11
Total of all active and inactive participants 2020-01-01 95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 1
Total participants 2020-01-01 96
Number of participants with account balances 2020-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 3
2019: OUR HOMES SOUTH, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 93
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 13
Total of all active and inactive participants 2019-01-01 106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 106
Number of participants with account balances 2019-01-01 59
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: OUR HOMES SOUTH, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 99
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 7
Total of all active and inactive participants 2018-01-01 106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 106
Number of participants with account balances 2018-01-01 57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: OUR HOMES SOUTH, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 92
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 8
Total of all active and inactive participants 2017-01-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 100
Number of participants with account balances 2017-01-01 54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: OUR HOMES SOUTH, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 94
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 1
Total of all active and inactive participants 2016-01-01 95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 95
Number of participants with account balances 2016-01-01 57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0

Measure	Date	Value
2021: OUR HOMES SOUTH, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	78
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	14
Total of all active and inactive participants	2021-01-01	92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	93
Number of participants with account balances	2021-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: OUR HOMES SOUTH, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	84
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	11
Total of all active and inactive participants	2020-01-01	95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	1
Total participants	2020-01-01	96
Number of participants with account balances	2020-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	3
2019: OUR HOMES SOUTH, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	93
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	13
Total of all active and inactive participants	2019-01-01	106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	106
Number of participants with account balances	2019-01-01	59
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: OUR HOMES SOUTH, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	99
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	7
Total of all active and inactive participants	2018-01-01	106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	106
Number of participants with account balances	2018-01-01	57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: OUR HOMES SOUTH, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	92
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	8
Total of all active and inactive participants	2017-01-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	100
Number of participants with account balances	2017-01-01	54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: OUR HOMES SOUTH, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	94
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	1
Total of all active and inactive participants	2016-01-01	95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	95
Number of participants with account balances	2016-01-01	57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0

Financial Data on OUR HOMES SOUTH, INC. 401(K) PLAN

Measure	Date	Value
2021 : OUR HOMES SOUTH, INC. 401(K) 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	$761,351
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$73,824
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$72,831
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$575,377
Value of total assets at end of year	2021-12-31	$1,638,721
Value of total assets at beginning of year	2021-12-31	$951,194
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$993
Total interest from all sources	2021-12-31	$2,441
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$170,000
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	$146,436
Participant contributions at end of year	2021-12-31	$12,871
Participant contributions at beginning of year	2021-12-31	$22,390
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$389,896
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	$687,527
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$1,638,721
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$951,194
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 pooled separate accounts at end of year	2021-12-31	$1,391,730
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$827,797
Interest on participant loans	2021-12-31	$949
Interest earned on other investments	2021-12-31	$1,492
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$195,075
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$69,989
Net investment gain/loss from pooled separate accounts	2021-12-31	$183,533
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	$39,045
Employer contributions (assets) at end of year	2021-12-31	$39,045
Employer contributions (assets) at beginning of year	2021-12-31	$31,018
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$72,831
Contract administrator fees	2021-12-31	$993
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	BOYUM & BARENSCHEER PLLP
Accountancy firm EIN	2021-12-31	416192096
2020 : OUR HOMES SOUTH, INC. 401(K) 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	$270,263
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$811,154
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$802,864
Expenses. Certain deemed distributions of participant loans	2020-12-31	$5,584
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$122,633
Value of total assets at end of year	2020-12-31	$951,194
Value of total assets at beginning of year	2020-12-31	$1,492,085
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$2,706
Total interest from all sources	2020-12-31	$3,547
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
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	$91,615
Participant contributions at end of year	2020-12-31	$22,390
Participant contributions at beginning of year	2020-12-31	$30,987
Total non interest bearing cash at end of year	2020-12-31	$31,018
Total non interest bearing cash at beginning of year	2020-12-31	$35,328
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	$-540,891
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$951,194
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,492,085
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 pooled separate accounts at end of year	2020-12-31	$827,797
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$1,179,736
Interest on participant loans	2020-12-31	$1,518
Interest earned on other investments	2020-12-31	$2,029
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$69,989
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$246,034
Net investment gain/loss from pooled separate accounts	2020-12-31	$144,083
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	$31,018
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$802,864
Contract administrator fees	2020-12-31	$2,706
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	Unqualified
Accountancy firm name	2020-12-31	BOYUM & BARENSCHEER PLLP
Accountancy firm EIN	2020-12-31	416192096
2019 : OUR HOMES SOUTH, INC. 401(K) 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	$351,292
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$100,590
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$99,447
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$130,553
Value of total assets at end of year	2019-12-31	$1,492,085
Value of total assets at beginning of year	2019-12-31	$1,241,383
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,143
Total interest from all sources	2019-12-31	$4,506
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
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
Value of fidelity bond cover	2019-12-31	$125,000
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	$93,638
Participant contributions at end of year	2019-12-31	$30,987
Participant contributions at beginning of year	2019-12-31	$26,502
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$1,587
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$250,702
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,492,085
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,241,383
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 pooled separate accounts at end of year	2019-12-31	$1,179,736
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$932,657
Interest on participant loans	2019-12-31	$1,768
Interest earned on other investments	2019-12-31	$2,738
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$246,034
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$245,454
Net investment gain/loss from pooled separate accounts	2019-12-31	$216,233
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	$35,328
Employer contributions (assets) at end of year	2019-12-31	$35,328
Employer contributions (assets) at beginning of year	2019-12-31	$36,770
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$99,447
Contract administrator fees	2019-12-31	$1,143
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	BOYUM & BARENSCHEER
Accountancy firm EIN	2019-12-31	416192096
2018 : OUR HOMES SOUTH, INC. 401(K) 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	$66,021
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$6,777
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$5,917
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$128,329
Value of total assets at end of year	2018-12-31	$1,241,383
Value of total assets at beginning of year	2018-12-31	$1,182,139
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$860
Total interest from all sources	2018-12-31	$3,186
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$125,000
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	$91,559
Participant contributions at end of year	2018-12-31	$26,502
Participant contributions at beginning of year	2018-12-31	$9,329
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	$59,244
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,241,383
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,182,139
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 pooled separate accounts at end of year	2018-12-31	$932,657
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$896,394
Interest on participant loans	2018-12-31	$826
Interest earned on other investments	2018-12-31	$2,360
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$245,454
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$203,967
Net investment gain/loss from pooled separate accounts	2018-12-31	$-65,494
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	$36,770
Employer contributions (assets) at end of year	2018-12-31	$36,770
Employer contributions (assets) at beginning of year	2018-12-31	$72,449
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$5,917
Contract administrator fees	2018-12-31	$860
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	BOYUM & BARENSCHEER
Accountancy firm EIN	2018-12-31	416192096
2017 : OUR HOMES SOUTH, INC. 401(K) 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	$297,680
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$34,379
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$33,765
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$181,593
Value of total assets at end of year	2017-12-31	$1,182,139
Value of total assets at beginning of year	2017-12-31	$918,838
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$614
Total interest from all sources	2017-12-31	$2,128
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$125,000
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	$109,144
Participant contributions at end of year	2017-12-31	$9,329
Participant contributions at beginning of year	2017-12-31	$0
Other income not declared elsewhere	2017-12-31	$13
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	$263,301
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,182,139
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$918,838
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 pooled separate accounts at end of year	2017-12-31	$896,394
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$665,081
Interest on participant loans	2017-12-31	$180
Interest earned on other investments	2017-12-31	$1,948
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$203,967
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$178,489
Net investment gain/loss from pooled separate accounts	2017-12-31	$113,946
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	No
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	$72,449
Employer contributions (assets) at end of year	2017-12-31	$72,449
Employer contributions (assets) at beginning of year	2017-12-31	$75,268
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$33,765
Contract administrator fees	2017-12-31	$614
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	BOYUM & BARENSCHEER PLLP
Accountancy firm EIN	2017-12-31	416192096
2016 : OUR HOMES SOUTH, INC. 401(K) 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	$921,251
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$2,413
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$2,248
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$876,741
Value of total assets at end of year	2016-12-31	$918,838
Value of total assets at beginning of year	2016-12-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$165
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$125,000
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	$109,492
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$691,981
Other income not declared elsewhere	2016-12-31	$1,296
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	$918,838
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$918,838
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$0
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 pooled separate accounts at end of year	2016-12-31	$665,081
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$178,489
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$0
Net investment gain/loss from pooled separate accounts	2016-12-31	$43,214
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	$75,268
Employer contributions (assets) at end of year	2016-12-31	$75,268
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$2,248
Contract administrator fees	2016-12-31	$165
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	BOYUM & BARENSCHEER, PLLP
Accountancy firm EIN	2016-12-31	416192096

Form 5500 Responses for OUR HOMES SOUTH, INC. 401(K) PLAN

2021: OUR HOMES SOUTH, INC. 401(K) 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: OUR HOMES SOUTH, INC. 401(K) 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: OUR HOMES SOUTH, INC. 401(K) 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: OUR HOMES SOUTH, INC. 401(K) 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: OUR HOMES SOUTH, INC. 401(K) 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: OUR HOMES SOUTH, INC. 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

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

Policy contract number

068908

Policy instance

Insurance contract or identification number	068908
Number of Individuals Covered	93
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,703
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 $6,703
Insurance broker organization code?	3

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

Policy contract number

068908

Policy instance

Insurance contract or identification number	068908
Number of Individuals Covered	96
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $5,549
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 $5,549
Insurance broker organization code?	3

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

Policy contract number

068908

Policy instance

Insurance contract or identification number	068908
Number of Individuals Covered	106
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,737
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
Commission paid to Insurance Broker	USD $6,737
Insurance broker organization code?	3

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

Policy contract number

068908

Policy instance

Insurance contract or identification number	068908
Number of Individuals Covered	107
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,054
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
Commission paid to Insurance Broker	USD $5,054
Insurance broker organization code?	3

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

Policy contract number

068908

Policy instance

Insurance contract or identification number	068908
Number of Individuals Covered	100
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,054
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
Commission paid to Insurance Broker	USD $5,054
Insurance broker organization code?	3
Insurance broker name	SECURIAN FINANCIAL SERVICES

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See full terms and conditions

Company Name:	OUR HOMES SOUTH, INC.
Employer identification number (EIN):	411759791
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	BELINDA ISAACSON	2023-07-10
001	2021-01-01
001	2020-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01	DENNIS BURGESS		DENNIS BURGESS	2019-07-24
001	2017-01-01	DENNIS BURGESS
001	2016-01-01	DENNIS BURGESS