401k Plan data: 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS plan

403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS 401k Plan overview

Plan Name	403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS
Plan identification number	003

403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	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

JEWISH FAMILY AND CHILDREN S SERVICE OF MINNEAPOLIS has sponsored the creation of one or more 401k plans.

Company Name: JEWISH FAMILY AND CHILDREN S SERVICE OF MINNEAPOLIS

Employer identification number (EIN): 410693860

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2012-10-01 BETH TOSO 2013-06-11 BETH TOSO 2013-06-11
003 2011-10-01 BETH TOSO BETH TOSO 2013-06-11
003 2010-10-01 TAMMY COHEN TAMMY COHEN 2012-07-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2012-10-01	BETH TOSO	2013-06-11	BETH TOSO	2013-06-11
003	2011-10-01	BETH TOSO		BETH TOSO	2013-06-11
003	2010-10-01	TAMMY COHEN		TAMMY COHEN	2012-07-16

Plan Statistics for 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS

401k plan membership statisitcs for 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS

Measure Date Value
2011: 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS 2011 401k membership
Total participants, beginning-of-year 2011-10-01 140
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 33
Number of retired or separated participants receiving benefits 2011-10-01 0
Number of other retired or separated participants entitled to future benefits 2011-10-01 13
Total of all active and inactive participants 2011-10-01 46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-10-01 0
Total participants 2011-10-01 46
Number of participants with account balances 2011-10-01 46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 0
2010: 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS 2010 401k membership
Total participants, beginning-of-year 2010-10-01 139
Total number of active participants reported on line 7a of the Form 5500 2010-10-01 137
Number of retired or separated participants receiving benefits 2010-10-01 0
Number of other retired or separated participants entitled to future benefits 2010-10-01 3
Total of all active and inactive participants 2010-10-01 140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-10-01 0
Total participants 2010-10-01 140
Number of participants with account balances 2010-10-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-10-01 0

Measure	Date	Value
2011: 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS 2011 401k membership
Total participants, beginning-of-year	2011-10-01	140
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	33
Number of retired or separated participants receiving benefits	2011-10-01	0
Number of other retired or separated participants entitled to future benefits	2011-10-01	13
Total of all active and inactive participants	2011-10-01	46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-10-01	0
Total participants	2011-10-01	46
Number of participants with account balances	2011-10-01	46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	0
2010: 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS 2010 401k membership
Total participants, beginning-of-year	2010-10-01	139
Total number of active participants reported on line 7a of the Form 5500	2010-10-01	137
Number of retired or separated participants receiving benefits	2010-10-01	0
Number of other retired or separated participants entitled to future benefits	2010-10-01	3
Total of all active and inactive participants	2010-10-01	140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-10-01	0
Total participants	2010-10-01	140
Number of participants with account balances	2010-10-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-10-01	0

Financial Data on 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS

Measure	Date	Value
2012 : 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-09-30	$0
Total income from all sources (including contributions)	2012-09-30	$251,092
Total loss/gain on sale of assets	2012-09-30	$0
Total of all expenses incurred	2012-09-30	$16,355
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-09-30	$16,355
Expenses. Certain deemed distributions of participant loans	2012-09-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-09-30	$187,859
Value of total assets at end of year	2012-09-30	$780,682
Value of total assets at beginning of year	2012-09-30	$545,945
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-09-30	$0
Total interest from all sources	2012-09-30	$3,199
Total dividends received (eg from common stock, registered investment company shares)	2012-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-09-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2012-09-30	$0
Was this plan covered by a fidelity bond	2012-09-30	Yes
Value of fidelity bond cover	2012-09-30	$500,000
If this is an individual account plan, was there a blackout period	2012-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2012-09-30	No
Contributions received from participants	2012-09-30	$143,796
Income. Received or receivable in cash from other sources (including rollovers)	2012-09-30	$44,063
Other income not declared elsewhere	2012-09-30	$0
Administrative expenses (other) incurred	2012-09-30	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-09-30	No
Value of net income/loss	2012-09-30	$234,737
Value of net assets at end of year (total assets less liabilities)	2012-09-30	$780,682
Value of net assets at beginning of year (total assets less liabilities)	2012-09-30	$545,945
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-09-30	No
Were any leases to which the plan was party in default or uncollectible	2012-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-09-30	$589,758
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-09-30	$379,575
Interest on participant loans	2012-09-30	$0
Interest earned on other investments	2012-09-30	$3,199
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-09-30	$190,924
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-09-30	$166,370
Expenses. Payments to insurance carriers foe the provision of benefits	2012-09-30	$0
Net investment gain/loss from pooled separate accounts	2012-09-30	$60,034
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-09-30	No
Was there a failure to transmit to the plan any participant contributions	2012-09-30	No
Has the plan failed to provide any benefit when due under the plan	2012-09-30	No
Contributions received in cash from employer	2012-09-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-09-30	$16,355
Did the plan have assets held for investment	2012-09-30	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	2012-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2012-09-30	Disclaimer
Accountancy firm name	2012-09-30	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2012-09-30	410746749
2011 : 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-09-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-09-30	$0
Total income from all sources (including contributions)	2011-09-30	$146,314
Total loss/gain on sale of assets	2011-09-30	$0
Total of all expenses incurred	2011-09-30	$9,093
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-09-30	$9,093
Expenses. Certain deemed distributions of participant loans	2011-09-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-09-30	$166,650
Value of total assets at end of year	2011-09-30	$545,945
Value of total assets at beginning of year	2011-09-30	$408,724
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-09-30	$0
Total interest from all sources	2011-09-30	$2,964
Total dividends received (eg from common stock, registered investment company shares)	2011-09-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-09-30	No
Was this plan covered by a fidelity bond	2011-09-30	Yes
Value of fidelity bond cover	2011-09-30	$500,000
If this is an individual account plan, was there a blackout period	2011-09-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-09-30	$0
Were there any nonexempt tranactions with any party-in-interest	2011-09-30	No
Contributions received from participants	2011-09-30	$109,877
Participant contributions at end of year	2011-09-30	$0
Participant contributions at beginning of year	2011-09-30	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-09-30	$56,773
Other income not declared elsewhere	2011-09-30	$0
Administrative expenses (other) incurred	2011-09-30	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-09-30	No
Value of net income/loss	2011-09-30	$137,221
Value of net assets at end of year (total assets less liabilities)	2011-09-30	$545,945
Value of net assets at beginning of year (total assets less liabilities)	2011-09-30	$408,724
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-09-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-09-30	No
Were any leases to which the plan was party in default or uncollectible	2011-09-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-09-30	$379,575
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-09-30	$284,026
Interest on participant loans	2011-09-30	$0
Interest earned on other investments	2011-09-30	$2,964
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-09-30	$166,370
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-09-30	$124,698
Expenses. Payments to insurance carriers foe the provision of benefits	2011-09-30	$0
Net investment gain/loss from pooled separate accounts	2011-09-30	$-23,300
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-09-30	No
Was there a failure to transmit to the plan any participant contributions	2011-09-30	No
Has the plan failed to provide any benefit when due under the plan	2011-09-30	No
Contributions received in cash from employer	2011-09-30	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-09-30	$9,093
Did the plan have assets held for investment	2011-09-30	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	2011-09-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-09-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-09-30	Yes
Opinion of an independent qualified public accountant for this plan	2011-09-30	Disclaimer
Accountancy firm name	2011-09-30	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2011-09-30	410746749

Form 5500 Responses for 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS

2011: 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2010: 403B PLAN OF JEWISH FAMILY AND CHILDREN'S SERVICE OF MINNEAPOLIS 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	Submission has been amended	No
2010-10-01	This submission is the final filing	No
2010-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-10-01	Plan is a collectively bargained plan	No
2010-10-01	Plan funding arrangement – Insurance	Yes
2010-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

005259K

Policy instance

Insurance contract or identification number	005259K
Number of Individuals Covered	46
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $449
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	1
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

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )

Policy contract number

005259K

Policy instance

Insurance contract or identification number	005259K
Number of Individuals Covered	42
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $641
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	1
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

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Company Name:	JEWISH FAMILY AND CHILDREN S SERVICE OF MINNEAPOLIS
Employer identification number (EIN):	410693860
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations