401k Plan data: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN plan

MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 401k Plan overview

Plan Name	MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN
Plan identification number	501

MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

MINOT VOCATIONAL ADJUSTMENT WORKSHOP D/B/A KALIX has sponsored the creation of one or more 401k plans.

Company Name: MINOT VOCATIONAL ADJUSTMENT WORKSHOP D/B/A KALIX

Employer identification number (EIN): 450313122

NAIC Classification: 624310
NAIC Description: Vocational Rehabilitation Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 CHRIS HASELEN 2024-10-11 CHRIS HASELEN 2024-10-11
501 2022-07-01 MISTY WANNER 2023-10-16
501 2021-07-01 BORGI BEELER 2023-04-14
501 2020-07-01 BORGI BEELER 2022-03-07
501 2019-07-01 JOY SMITH 2021-02-01
501 2018-07-01 BORGI BEELER 2020-01-30
501 2017-07-01
501 2016-07-01
501 2016-07-01 BORGI BEELER 2018-01-30
501 2015-07-01
501 2014-07-01
501 2012-07-01 BORGI BEELER
501 2011-07-01 BORGI BEELER
501 2010-07-01 BORGI BEELER
501 2009-07-01 BORGI BEELER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	CHRIS HASELEN	2024-10-11	CHRIS HASELEN	2024-10-11
501	2022-07-01	MISTY WANNER	2023-10-16
501	2021-07-01	BORGI BEELER	2023-04-14
501	2020-07-01	BORGI BEELER	2022-03-07
501	2019-07-01	JOY SMITH	2021-02-01
501	2018-07-01	BORGI BEELER	2020-01-30
501	2017-07-01
501	2016-07-01
501	2016-07-01	BORGI BEELER	2018-01-30
501	2015-07-01
501	2014-07-01
501	2012-07-01	BORGI BEELER
501	2011-07-01	BORGI BEELER
501	2010-07-01	BORGI BEELER
501	2009-07-01	BORGI BEELER

Form 5500 Responses for MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN

2023: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	This submission is the final filing	Yes
2022-07-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2021: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	First time form 5500 has been submitted	Yes
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	This submission is the final filing	Yes
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	Yes
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2012: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2010: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2009: MINOT VOCATIONAL ADJUSTMENT WORKSHOP - PRINCIPAL FINANCIAL BENEFIT PLAN 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	This submission is the final filing	No
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

370782

Policy instance

Insurance contract or identification number	370782
Number of Individuals Covered	260
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $11,946
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $112,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

445998

Policy instance

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

000000445998

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010218177

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010218176

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010218176

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010218177

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010218177

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010218176

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010218177

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010218176

Policy instance

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

Policy contract number

N90718

Policy instance

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

Policy contract number

N90718

Policy instance

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

Policy contract number

N90718

Policy instance

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

Policy contract number

N90718

Policy instance

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

Policy contract number

N90718

Policy instance

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Company Name:	MINOT VOCATIONAL ADJUSTMENT WORKSHOP D/B/A KALIX
Employer identification number (EIN):	450313122
NAIC Classification:	624310
NAIC Description:	Vocational Rehabilitation Services