401k Plan data: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN plan

FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN
Plan identification number	002

FIRST AMERICAN 401(K) RETIREMENT SAVINGS 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.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

FIRST AMERICAN ENTERPRISES,INC has sponsored the creation of one or more 401k plans.

Company Name: FIRST AMERICAN ENTERPRISES,INC

Employer identification number (EIN): 411234418

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2021-01-01 ERIC QUELLA 2021-07-07
002 2020-01-01 ERIC QUELLA 2021-07-07
002 2019-01-01
002 2013-01-01 DAVID ERICKSON
002 2012-01-01 DAVID W. ERICKSON 2013-10-14
002 2011-01-01 BARBARA MACE 2012-07-31
002 2010-01-01 BARBARA MACE 2011-10-13
002 2009-01-01 BARBARA MACE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2021-01-01	ERIC QUELLA	2021-07-07
002	2020-01-01	ERIC QUELLA	2021-07-07
002	2019-01-01
002	2013-01-01	DAVID ERICKSON
002	2012-01-01	DAVID W. ERICKSON	2013-10-14
002	2011-01-01	BARBARA MACE	2012-07-31
002	2010-01-01	BARBARA MACE	2011-10-13
002	2009-01-01	BARBARA MACE

Plan Statistics for FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN

Measure Date Value
2019: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 48
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 22
Total of all active and inactive participants 2019-01-01 70
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 70
Number of participants with account balances 2019-01-01 64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 5
2013: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 224
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 186
Number of retired or separated participants receiving benefits 2013-01-01 12
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 198
Number of participants with account balances 2013-01-01 78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2009: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 103
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 1
Total of all active and inactive participants 2009-01-01 104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 104
Number of participants with account balances 2009-01-01 39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2019: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	48
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	22
Total of all active and inactive participants	2019-01-01	70
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	70
Number of participants with account balances	2019-01-01	64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	5
2013: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	224
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	186
Number of retired or separated participants receiving benefits	2013-01-01	12
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	198
Number of participants with account balances	2013-01-01	78
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2009: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	103
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	1
Total of all active and inactive participants	2009-01-01	104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	104
Number of participants with account balances	2009-01-01	39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN

Measure	Date	Value
2019 : FIRST AMERICAN 401(K) RETIREMENT SAVINGS 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	$237,734
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$247,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$230,336
Expenses. Certain deemed distributions of participant loans	2019-12-31	$5,686
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$59,855
Value of total assets at end of year	2019-12-31	$1,196,114
Value of total assets at beginning of year	2019-12-31	$1,206,087
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$11,685
Total interest from all sources	2019-12-31	$617
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$8,116
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$8,116
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
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	$47,825
Participant contributions at end of year	2019-12-31	$5,657
Participant contributions at beginning of year	2019-12-31	$15,446
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	$-9,973
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,196,114
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,206,087
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 registered invesment companies (eg mutual funds) at end of year	2019-12-31	$807,198
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$741,009
Value of interest in pooled separate accounts at end of year	2019-12-31	$53,299
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$53,091
Interest on participant loans	2019-12-31	$617
Value of interest in common/collective trusts at end of year	2019-12-31	$329,960
Value of interest in common/collective trusts at beginning of year	2019-12-31	$396,541
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$152,799
Net investment gain/loss from pooled separate accounts	2019-12-31	$10,728
Net investment gain or loss from common/collective trusts	2019-12-31	$5,619
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	$12,030
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$230,336
Contract administrator fees	2019-12-31	$11,685
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	BERGANKDV, LTD
Accountancy firm EIN	2019-12-31	411431613
2013 : FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$345,505
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$136,062
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$131,561
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$154,089
Value of total assets at end of year	2013-12-31	$1,419,519
Value of total assets at beginning of year	2013-12-31	$1,210,076
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$4,501
Total interest from all sources	2013-12-31	$191,416
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$109,792
Participant contributions at end of year	2013-12-31	$35,637
Participant contributions at beginning of year	2013-12-31	$41,642
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$21,180
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$209,443
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$1,419,519
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,210,076
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in pooled separate accounts at end of year	2013-12-31	$1,383,882
Value of interest in pooled separate accounts at beginning of year	2013-12-31	$1,168,434
Interest on participant loans	2013-12-31	$2,248
Interest earned on other investments	2013-12-31	$189,168
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$23,117
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$131,561
Contract administrator fees	2013-12-31	$4,501
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	KERN, DEWENTER, VIERE, LTD.
Accountancy firm EIN	2013-12-31	411431613
2009 : FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN

2019: FIRST AMERICAN 401(K) RETIREMENT SAVINGS 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
2013: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2009: FIRST AMERICAN 401(K) RETIREMENT SAVINGS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	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

618342

Policy instance

Insurance contract or identification number	618342
Number of Individuals Covered	102
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $266
Total amount of fees paid to insurance company	USD $27
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $266
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

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

Policy contract number

618342

Policy instance

Insurance contract or identification number	618342
Number of Individuals Covered	274
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,895
Total amount of fees paid to insurance company	USD $1,435
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,895
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	VALMARK SECURITIES

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Company Name:	FIRST AMERICAN ENTERPRISES,INC
Employer identification number (EIN):	411234418
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities