401k Plan data: FSI, INC. 401(K) & PROFIT SHARING PLAN plan

FSI, INC. 401(K) & PROFIT SHARING PLAN 401k Plan overview

Plan Name	FSI, INC. 401(K) & PROFIT SHARING PLAN
Plan identification number	001

FSI, INC. 401(K) & PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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 theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

FSI, INC. has sponsored the creation of one or more 401k plans.

Company Name: FSI, INC.

Employer identification number (EIN): 391751953

NAIC Classification: 722513
NAIC Description: Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FSI, INC. 401(K) & PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 CHELSEY WENDT 2023-10-16
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2019-01-01
001 2018-01-01 ABBY STRUNZ 2019-10-14
001 2017-01-01 ABBY STRUNZ 2018-10-15
001 2016-01-01 ABIGAIL STRUNZ 2017-10-16 ABIGAIL STRUNZ 2017-10-16
001 2015-01-01 TAMMY GETSCHMAN 2016-06-03
001 2014-01-01 TAMMY GETSCHMAN 2015-07-06

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	CHELSEY WENDT	2023-10-16
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2019-01-01
001	2018-01-01	ABBY STRUNZ	2019-10-14
001	2017-01-01	ABBY STRUNZ	2018-10-15
001	2016-01-01	ABIGAIL STRUNZ	2017-10-16	ABIGAIL STRUNZ	2017-10-16
001	2015-01-01	TAMMY GETSCHMAN	2016-06-03
001	2014-01-01	TAMMY GETSCHMAN	2015-07-06

Plan Statistics for FSI, INC. 401(K) & PROFIT SHARING PLAN

401k plan membership statisitcs for FSI, INC. 401(K) & PROFIT SHARING PLAN

Measure Date Value
2022: FSI, INC. 401(K) & PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 869
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,347
Number of retired or separated participants receiving benefits 2022-01-01 1
Number of other retired or separated participants entitled to future benefits 2022-01-01 51
Total of all active and inactive participants 2022-01-01 1,399
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 1,399
Number of participants with account balances 2022-01-01 248
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: FSI, INC. 401(K) & PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 692
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 837
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 21
Total of all active and inactive participants 2021-01-01 858
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 858
Number of participants with account balances 2021-01-01 185
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: FSI, INC. 401(K) & PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 579
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 575
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 26
Total of all active and inactive participants 2020-01-01 601
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 601
Number of participants with account balances 2020-01-01 149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: FSI, INC. 401(K) & PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 488
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 17
Total of all active and inactive participants 2019-01-01 505
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 505
Number of participants with account balances 2019-01-01 117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0

Measure	Date	Value
2022: FSI, INC. 401(K) & PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	869
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,347
Number of retired or separated participants receiving benefits	2022-01-01	1
Number of other retired or separated participants entitled to future benefits	2022-01-01	51
Total of all active and inactive participants	2022-01-01	1,399
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	1,399
Number of participants with account balances	2022-01-01	248
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: FSI, INC. 401(K) & PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	692
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	837
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	21
Total of all active and inactive participants	2021-01-01	858
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	858
Number of participants with account balances	2021-01-01	185
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: FSI, INC. 401(K) & PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	579
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	575
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	26
Total of all active and inactive participants	2020-01-01	601
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	601
Number of participants with account balances	2020-01-01	149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: FSI, INC. 401(K) & PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	488
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	17
Total of all active and inactive participants	2019-01-01	505
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	505
Number of participants with account balances	2019-01-01	117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0

Financial Data on FSI, INC. 401(K) & PROFIT SHARING PLAN

Measure	Date	Value
2022 : FSI, INC. 401(K) & PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$399,756
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$153,824
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$144,236
Expenses. Certain deemed distributions of participant loans	2022-12-31	$2,666
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,169,300
Value of total assets at end of year	2022-12-31	$4,601,580
Value of total assets at beginning of year	2022-12-31	$4,355,648
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$6,922
Total interest from all sources	2022-12-31	$4,045
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$325,026
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$325,026
Administrative expenses professional fees incurred	2022-12-31	$6,922
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$769,622
Participant contributions at end of year	2022-12-31	$109,950
Participant contributions at beginning of year	2022-12-31	$87,490
Participant contributions at end of year	2022-12-31	$8,390
Participant contributions at beginning of year	2022-12-31	$6,056
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$39,715
Other income not declared elsewhere	2022-12-31	$34
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$245,932
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,601,580
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$4,355,648
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$4,458,660
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$4,236,247
Interest on participant loans	2022-12-31	$3,839
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$206
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$20,156
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$22,367
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,098,649
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$359,963
Employer contributions (assets) at end of year	2022-12-31	$4,424
Employer contributions (assets) at beginning of year	2022-12-31	$3,488
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$144,236
Did the plan have assets held for investment	2022-12-31	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	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MBE CPAS, LLP
Accountancy firm EIN	2022-12-31	200794302
2021 : FSI, INC. 401(K) & PROFIT SHARING 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	$1,331,357
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$51,609
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$45,511
Expenses. Certain deemed distributions of participant loans	2021-12-31	$2,461
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$835,708
Value of total assets at end of year	2021-12-31	$4,355,648
Value of total assets at beginning of year	2021-12-31	$3,075,900
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$3,637
Total interest from all sources	2021-12-31	$4,155
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$426,765
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$426,765
Administrative expenses professional fees incurred	2021-12-31	$3,637
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
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	$537,044
Participant contributions at end of year	2021-12-31	$87,490
Participant contributions at beginning of year	2021-12-31	$76,520
Participant contributions at end of year	2021-12-31	$6,056
Participant contributions at beginning of year	2021-12-31	$2,811
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$54,513
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	$1,279,748
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$4,355,648
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$3,075,900
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 registered invesment companies (eg mutual funds) at end of year	2021-12-31	$4,236,247
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,985,704
Interest on participant loans	2021-12-31	$4,045
Interest earned on other investments	2021-12-31	$110
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$22,367
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$8,924
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$64,729
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	$244,151
Employer contributions (assets) at end of year	2021-12-31	$3,488
Employer contributions (assets) at beginning of year	2021-12-31	$1,941
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$45,511
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	Disclaimer
Accountancy firm name	2021-12-31	MBE CPAS, LLP
Accountancy firm EIN	2021-12-31	200794302
2020 : FSI, INC. 401(K) & PROFIT SHARING 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	$966,924
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$43,077
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$41,528
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$573,657
Value of total assets at end of year	2020-12-31	$3,075,900
Value of total assets at beginning of year	2020-12-31	$2,152,053
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$1,549
Total interest from all sources	2020-12-31	$4,219
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$139,106
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$139,106
Administrative expenses professional fees incurred	2020-12-31	$1,549
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	$377,338
Participant contributions at end of year	2020-12-31	$76,520
Participant contributions at beginning of year	2020-12-31	$83,278
Participant contributions at end of year	2020-12-31	$2,811
Participant contributions at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$35,188
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	$923,847
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,075,900
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,152,053
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 registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,985,704
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$2,066,268
Interest on participant loans	2020-12-31	$4,167
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$2,507
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$2,507
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$52
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$8,924
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$249,942
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	$161,131
Employer contributions (assets) at end of year	2020-12-31	$1,941
Employer contributions (assets) at beginning of year	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$41,528
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	Disclaimer
Accountancy firm name	2020-12-31	MBE CPAS, LLP
Accountancy firm EIN	2020-12-31	200794302
2019 : FSI, INC. 401(K) & PROFIT SHARING PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total transfer of assets to this plan	2019-12-31	$606,445
Total transfer of assets to this plan	2019-12-31	$606,445
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	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 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	$886,271
Total income from all sources (including contributions)	2019-12-31	$886,271
Total loss/gain on sale of assets	2019-12-31	$0
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$106,133
Total of all expenses incurred	2019-12-31	$106,133
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$97,123
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$97,123
Expenses. Certain deemed distributions of participant loans	2019-12-31	$7,575
Expenses. Certain deemed distributions of participant loans	2019-12-31	$7,575
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$537,068
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$537,068
Value of total assets at end of year	2019-12-31	$2,152,053
Value of total assets at end of year	2019-12-31	$2,152,053
Value of total assets at beginning of year	2019-12-31	$765,470
Value of total assets at beginning of year	2019-12-31	$765,470
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,435
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$1,435
Total interest from all sources	2019-12-31	$3,244
Total interest from all sources	2019-12-31	$3,244
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$149,696
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$149,696
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$149,696
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$149,696
Administrative expenses professional fees incurred	2019-12-31	$1,435
Administrative expenses professional fees incurred	2019-12-31	$1,435
Was this plan covered by a fidelity bond	2019-12-31	Yes
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$250,000
Value of fidelity bond cover	2019-12-31	$250,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
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
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$308,128
Contributions received from participants	2019-12-31	$308,128
Participant contributions at end of year	2019-12-31	$83,278
Participant contributions at end of year	2019-12-31	$83,278
Participant contributions at beginning of year	2019-12-31	$15,795
Participant contributions at beginning of year	2019-12-31	$15,795
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$105,221
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$105,221
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
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	$780,138
Value of net income/loss	2019-12-31	$780,138
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,152,053
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,152,053
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$765,470
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$765,470
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
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 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
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	$2,066,268
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,066,268
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$749,541
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$749,541
Interest on participant loans	2019-12-31	$3,230
Interest on participant loans	2019-12-31	$3,230
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$2,507
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$2,507
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$134
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$134
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$134
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$134
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$14
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$14
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$196,263
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$196,263
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
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
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
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	$123,719
Contributions received in cash from employer	2019-12-31	$123,719
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$97,123
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$97,123
Did the plan have assets held for investment	2019-12-31	Yes
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
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
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
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
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MBE CPAS, LLP
Accountancy firm name	2019-12-31	MBE CPAS, LLP
Accountancy firm EIN	2019-12-31	200794302
Accountancy firm EIN	2019-12-31	200794302

Form 5500 Responses for FSI, INC. 401(K) & PROFIT SHARING PLAN

2022: FSI, INC. 401(K) & PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: FSI, INC. 401(K) & PROFIT SHARING 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: FSI, INC. 401(K) & PROFIT SHARING 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: FSI, INC. 401(K) & PROFIT SHARING 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 – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

50357301

Policy instance

Insurance contract or identification number	50357301
Number of Individuals Covered	26
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $19
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 $19
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

50357301

Policy instance

Insurance contract or identification number	50357301
Number of Individuals Covered	19
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $19
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 $19
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

50357301

Policy instance

Insurance contract or identification number	50357301
Number of Individuals Covered	9
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $7
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 $7
Insurance broker organization code?	3

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

50357301

Policy instance

Insurance contract or identification number	50357301
Number of Individuals Covered	8
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2
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 $2
Insurance broker organization code?	3

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Company Name:	FSI, INC.
Employer identification number (EIN):	391751953
NAIC Classification:	722513
NAIC Description:	Limited-Service Restaurants