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NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN 401k Plan overview

Plan NameNORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN
Plan identification number 003

NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.

401k Sponsoring company profile

NORTHLAND LUTHERAN SERVICES FOR THE EDLERLY, INC. has sponsored the creation of one or more 401k plans.

Company Name:NORTHLAND LUTHERAN SERVICES FOR THE EDLERLY, INC.
Employer identification number (EIN):390859107
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032011-01-01GARY GUSTAFSON
0032010-01-01GARY GUSTAFSON
0032009-01-01GARY GUSTAFSON

Plan Statistics for NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN

401k plan membership statisitcs for NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN

Measure Date Value
2011: NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01101
Total number of active participants reported on line 7a of the Form 55002011-01-0157
Number of retired or separated participants receiving benefits2011-01-0143
Total of all active and inactive participants2011-01-01100
Total participants2011-01-01100
Number of participants with account balances2011-01-01100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01121
Total number of active participants reported on line 7a of the Form 55002010-01-0165
Number of retired or separated participants receiving benefits2010-01-0136
Total of all active and inactive participants2010-01-01101
Total participants2010-01-01101
Number of participants with account balances2010-01-01101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01121
Total number of active participants reported on line 7a of the Form 55002009-01-0181
Number of retired or separated participants receiving benefits2009-01-0140
Total of all active and inactive participants2009-01-01121
Total participants2009-01-01121
Number of participants with account balances2009-01-01121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN

Measure Date Value
2011 : NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN 2011 401k financial data
Total income from all sources (including contributions)2011-12-31$126,264
Total of all expenses incurred2011-12-31$252,841
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$252,841
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$112,765
Value of total assets at end of year2011-12-31$3,832,462
Value of total assets at beginning of year2011-12-31$3,959,039
Total interest from all sources2011-12-31$60,597
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$400,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$78,165
Participant contributions at end of year2011-12-31$39,036
Participant contributions at beginning of year2011-12-31$37,897
Other income not declared elsewhere2011-12-31$25
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-126,577
Value of net assets at end of year (total assets less liabilities)2011-12-31$3,832,462
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$3,959,039
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$1,995,385
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$2,166,820
Interest earned on other investments2011-12-31$60,597
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$1,798,041
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$1,754,014
Net investment gain/loss from pooled separate accounts2011-12-31$-47,123
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$34,600
Employer contributions (assets) at end of year2011-12-31$0
Employer contributions (assets) at beginning of year2011-12-31$308
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$252,841
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31UNGER & WALTERS, S.C.
Accountancy firm EIN2011-12-31271329873
2010 : NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN 2010 401k financial data
Total income from all sources (including contributions)2010-12-31$416,642
Total of all expenses incurred2010-12-31$217,826
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$217,826
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$114,798
Value of total assets at end of year2010-12-31$3,959,039
Value of total assets at beginning of year2010-12-31$3,760,223
Total interest from all sources2010-12-31$60,122
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$380,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$76,791
Participant contributions at end of year2010-12-31$37,897
Participant contributions at beginning of year2010-12-31$41,726
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$198,816
Value of net assets at end of year (total assets less liabilities)2010-12-31$3,959,039
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$3,760,223
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$2,166,820
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$1,961,107
Interest earned on other investments2010-12-31$60,122
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$1,754,014
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$1,757,390
Net investment gain/loss from pooled separate accounts2010-12-31$241,722
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$38,007
Employer contributions (assets) at end of year2010-12-31$308
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$217,826
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31UNGER & WALTERS, S.C.
Accountancy firm EIN2010-12-31271329873
2009 : NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN

2011: NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01First time form 5500 has been submittedYes
2010-01-01Submission has been amendedYes
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: NORTHLAND LUTHERAN SERVICES IRS CODE SECTION 403B TSA PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01First time form 5500 has been submittedYes
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

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