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Plan Information

  • Plan Year01/01/2019 — 12/31/2019
  • Date of Plan01/01/1993
  • Net Assets as of 12/31/2019 $28,395,659
  • Plan Number1
  • Plan Type Single Employer
  • Is the plan collectively bargained? No
  • Did the plan file for an extension of time or the DFVC Program? No
  • Plan Funding ArrangementInsurance Trust
  • Plan Benefit ArrangementInsurance Trust

Participant Information as of 12/31/2019

  • Active (Eligible) Participants141
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits41
  • Subtotal182
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total182
  • Total number of participants as of 01/01/2019196
  • Number of participants with account balances179
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested12


  • Total Benefit Payments$0
  • Corrective Distributions$0
  • Administrative Service Providers$0
  • Other Expenses$0
  • Total Expenses$0
  • Total Transfers$0

Sponsor Information

  • Address2300 Berkshire Lane N, Suite 200 Suite 200
  • CityPlymouth
  • StateMN
  • Zip55441
  • Telephone(763) 559-9100
  • EIN20-5980566
  • Industry Code541330
  • Named AdministratorKelsey Brown
  • Named Plan SponsorKelsey Brown

Audit Information

  • Audit StatusAudited
  • AuditorWipfli LLP
  • Auditor EIN39-0758449
  • Audit Opinion Disclaimer
  • Audit TypeLimited Scope Audit

Benefits Provided Under the Plan

Code Benefit Description
2A Age/Service Weighted or New Comparability or Similar Plan Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New Comparability or Similar Plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the threshold or additional rate allowed under the permitted disparity rules of section 401(l)
2E Profit-sharing A defined contribution plan that allows employer discretionary contributions. These plans often contain a 401(k) feature.
2F ERISA section 404(c) Plan This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
2G 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.
2J 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.
2K 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 contributions 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.
2T Participant-directed Account Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
3D 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.

Questions and Answers

Question Answer Amount
During the plan year did the employer fail to transmit to the plan any participant contributions within the time period described in 29 CFT 2510.3-102? No
Were any loans by the plan or fixed income obligations due the plan in default as of the close of plan year or classified during the year as uncollectible? Disregard participant loans secured by participant's account balance. No
Were any leases to which the plan was a party in default or classified during the year as uncollectible? No
Were there any nonexempt transactions with any party-in-interest? No
Was this plan covered by a fidelity bond? Yes $500,000
Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud or dishonesty? No
Did the plan hold any assets whose current value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan receive any noncash contributions whose value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan have assets held for investment? Yes
Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? No
Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? No
Has the plan failed to provide any benefit when due under the plan? No
If this is an individual account plan, was there a blackout period? No
If there was a blackout period, have you either provided the required notice or one of the exceptions to providing the notice applied under 29 CFR 2520.101-3? No


Income and Expense Statement

Income $7,450,456
Contributions $2,468,957
Cash Contributions $2,468,957
Cash from Employers $1,646,095
Cash from Participants $643,278
Others (including rollovers) $179,584
Noncash Contributions $0
Total Earnings on Investments $4,981,499
Total Interest $37,085
Interest-Bearing Cash $0
U.S. Government Securities $0
Corporate Debt Instruments $0
Loans (other than to participants) $0
Participant Loans $5,085
Interest from Other Investments $32,000
Total Dividends $704,681
Preferred Stock $0
Common Stock $0
Rents $0
Net gain (loss) on sale of assets $0
Aggregate Proceeds $0
Aggregate Carrying Amount $0
Total Unrealized Appreciation (depreciation) of assets $0
Real Estate $0
Other $0
Net investment gain (loss) from common/collective trusts $0
Net investment gain (loss) from pooled separate accounts $0
Net investment gain (loss) from master trust investment accounts $0
Net investment gain (loss) from 103-12 investment entities $0
Net investment gain (loss) from registered investment companies $4,239,733
Other Income $0
Expenses $1,054,600
Total Benefit Payments $1,008,427
Directly to participants or beneficiaries, including direct rollovers $1,008,427
To insurance carriers for the provision of benefits $0
Other Benefit Payment Fees $0
Corrective Distributions $0
Certain deemed distributions of participant loans $9,703
Interest expense $0
Total Administrative Expenses $36,470
Professional Fees $0
Contract Administrator Fees $36,470
Investment Advisory and management fees $0
Other Administrative Fees $0
Net Income $6,395,856
Transfers of Assets to this Plan $0
Transfers of Assets from this Plan $0

Asset and Liability Statement

12/31/2019 12/31/2018 Change YOY
Total Assets $28,395,659 $21,999,803 29.07%
Total noninterest-bearing cash $0 $0 0.0%
Receivables $1,645,476 $1,631,816 0.84%
Employer Contributions $1,645,476 $1,631,816 0.84%
Participant Contributions $0 $0 0.0%
Other Contributions $0 $0 0.0%
General Investments $0 $0 0.0%
Interest-bearing cash $0 $0 0.0%
U.S. Government Securities $0 $0 0.0%
Corporate Debt Instruments $0 $0 0.0%
Preferred $0 $0 0.0%
All Other $0 $0 0.0%
Corporate Stocks $0 $0 0.0%
Preferred $0 $0 0.0%
Common $0 $0 0.0%
Partnership/joint venture interests $0 $0 0.0%
Real estate (other than employer real property) $0 $0 0.0%
Loans (other than to participants) $0 $0 0.0%
Participants Loans $89,372 $101,244 -11.73%
Value of interest in common/collective trusts $0 $0 0.0%
Value of interest in pooled separate accounts $0 $0 0.0%
Value of interest in master trust investment accounts $0 $0 0.0%
Value of interest in 103-12 investment entities $0 $0 0.0%
Value of interest in registered investment companies $23,119,452 $16,960,171 36.32%
Value of funds held in insurance co. general account $3,541,359 $3,306,572 7.10%
Other Investments $0 $0 0.0%
Employer-related Investments $0 $0 0.0%
Employer Securities $0 $0 0.0%
Employer Real Property $0 $0 0.0%
Buildings and other property used in plan operation $0 $0 0.0%
Total Liabilities $0 $0 0.0%
Benefit Claims Payable (1) $0 $0 0.0%
Operating Payables (1) $0 $0 0.0%
Acquisition Indebtedness (1) $0 $0 0.0%
Other liabilities (1) $0 $0 0.0%
Net Assets $28,395,659 $21,999,803 29.07%

Service Providers

Persons Receiving Only Eligible Indirect Compensation

There is no information on eligible indirect compensation for this plan.

Other Service Providers Receiving Direct or Indirect Compensation

Name Nature of Service Relationship to Plan Sponsor Direct Compensation Paid by Plan Indirect Compensation Paid by Plan Total Compensation
Lpl Financial Investment advisory (plan) $23,000 $0 $23,000
Tax Sheltered Compensation Contract Administrator $1,999 $9,999 $11,998
WipfliLLP Accounting (including auditing) $8,500 $0 $8,500
Advised Assets Group Investment management $7,764 $0 $7,764
Great West Life & Annuity Insurance Recordkeeping fees $6,062 $0 $6,062
Total $47,325 $9,999 $57,324

Indirect Compensation

Name Source of Indirect Compensation* Nature of Service Description of Indirect Compensation Indirect Compensation Paid by Plan
Tax Sheltered Compensation, Inc. Great-West Life & Annuity Insurance Contract Administrator Tpa Allowance Payment $9,999
*As outlined by the Form 5500 Instructions for service providers with indirect compensation.

Service Providers Who Fail or Refuse to Provide Information

There are no service providers who failed or refused to provide information.

Termination Information on Accountants and Enrolled Actuaries

There is no termination information for this plan.



Name of Investment Investment Manager Type of Investment Dollar Value
Flexpath Index Moderate 2045 R1 Ast Wilmington Trust DFE: Common/Collective Trust $2,601,877
Flexpath Index Moderate 2035 R1 Ast Wilmington Trust DFE: Common/Collective Trust $994,950
Flexpath Index Moderate 2025 R1 Ast Wilmington Trust DFE: Common/Collective Trust $731,641
Flexpath Index Moderate 2055 R1 Ast Wilmington Trust DFE: Common/Collective Trust $703,902
Flexpath Index Moderate Retire R1 Ast Wilmington Trust DFE: Common/Collective Trust $426,137
Flexpath Index Conservative 2025 R1 Ast Wilmington Trust DFE: Common/Collective Trust $13,325
Flexpath Conservative 2055 R1 Ast Wilmington Trust DFE: Common/Collective Trust $712
Total $5,472,544

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Great-West Life & Annuity Insurance Company 44
EIN 84-0467907
Industry Code 68322
Contract Number 332411-01
Contract Year 01/01/2019 — 12/31/2019
Value in General Account at Year End $35,413,589
Value in Separate Accounts at Year End $0
Insurance Fees and Commissions $0
Persons Receiving Commissions and Fees There are no brokers listed for this plan.
Allocated Funds
Type of Contract Unspecified
Basis of premium rates
Premiums paid to carrier $0
Premiums due but unpaid at the end of the year $0
If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount $0
Specify the nature of the costs
Unallocated Funds
Balance at the end of the previous year $3,306,572
Additions $744,089
Contributions Deposited during the year $268,516
Dividends and credits $0
Interest credited during the year $41,937
Transferred from separate account $400,293
Other $33,343
Total of Balance and Additions $4,050,661
Deductions $509,302
Disbursed from fund to pay benefits or purchase annuities during the year $245,540
Administration charge made by carrier $-4,728
Transferred to Separate Account $268,490
Other $0
Balance at the end of the current year $3,541,359