401k Plan data: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN plan

SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 401k Plan overview

Plan Name	SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN
Plan identification number	002

SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN Benefits

401k Plan Type

Defined 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.
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.

401k Sponsoring company profile

SIOUXLAND MENTAL HEALTH SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: SIOUXLAND MENTAL HEALTH SERVICES, INC.

Employer identification number (EIN): 426122297

NAIC Classification: 621330
NAIC Description: Offices of Mental Health Practitioners (except Physicians)

Additional information about SIOUXLAND MENTAL HEALTH SERVICES, INC.

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities

Incorporation Date: 1968-05-20

Company Identification Number: 063211

Legal Registered Office Address: 625 COURT ST

SIOUX CITY
United States of America (USA)
51101

More information about SIOUXLAND MENTAL HEALTH SERVICES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01 SHEILA L. MARTIN SHEILA L. MARTIN 2018-10-10
002 2016-01-01 SHEILA L. MARTIN 2017-07-24 SHEILA L. MARTIN 2017-07-24
002 2015-01-01 JAMES RIXNER 2016-07-25 JAMES RIXNER 2016-07-25
002 2014-01-01 JAMES RIXNER 2015-07-20 JAMES RIXNER 2015-07-20
002 2013-01-01 JAMES RIXNER 2014-06-05 JAMES RIXNER 2014-06-05
002 2012-01-01 JAMES RIXNER 2013-06-11 JAMES RIXNER 2013-06-11
002 2011-01-01 JAMES RIXNER 2012-07-12 JAMES RIXNER 2012-07-12
002 2010-01-01 JAMES RIXNER 2011-07-25 JAMES RIXNER 2011-07-25

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01	SHEILA L. MARTIN		SHEILA L. MARTIN	2018-10-10
002	2016-01-01	SHEILA L. MARTIN	2017-07-24	SHEILA L. MARTIN	2017-07-24
002	2015-01-01	JAMES RIXNER	2016-07-25	JAMES RIXNER	2016-07-25
002	2014-01-01	JAMES RIXNER	2015-07-20	JAMES RIXNER	2015-07-20
002	2013-01-01	JAMES RIXNER	2014-06-05	JAMES RIXNER	2014-06-05
002	2012-01-01	JAMES RIXNER	2013-06-11	JAMES RIXNER	2013-06-11
002	2011-01-01	JAMES RIXNER	2012-07-12	JAMES RIXNER	2012-07-12
002	2010-01-01	JAMES RIXNER	2011-07-25	JAMES RIXNER	2011-07-25

Plan Statistics for SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN

401k plan membership statisitcs for SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN

Measure Date Value
2022: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 122
Number of retired or separated participants receiving benefits 2022-01-01 2
Number of other retired or separated participants entitled to future benefits 2022-01-01 34
Total of all active and inactive participants 2022-01-01 158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 1
Total participants 2022-01-01 159
Number of participants with account balances 2022-01-01 99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 2
2021: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 108
Number of other retired or separated participants entitled to future benefits 2021-01-01 29
Total of all active and inactive participants 2021-01-01 137
Total participants 2021-01-01 137
Number of participants with account balances 2021-01-01 137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 3
2020: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 93
Number of other retired or separated participants entitled to future benefits 2020-01-01 32
Total of all active and inactive participants 2020-01-01 125
Total participants 2020-01-01 125
Number of participants with account balances 2020-01-01 98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 5
2019: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 96
Number of other retired or separated participants entitled to future benefits 2019-01-01 26
Total of all active and inactive participants 2019-01-01 122
Total participants 2019-01-01 122
Number of participants with account balances 2019-01-01 101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 4
2018: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 91
Number of other retired or separated participants entitled to future benefits 2018-01-01 33
Total of all active and inactive participants 2018-01-01 124
Total participants 2018-01-01 124
Number of participants with account balances 2018-01-01 108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 7
2017: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 104
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 96
Number of other retired or separated participants entitled to future benefits 2017-01-01 24
Total of all active and inactive participants 2017-01-01 120
Total participants 2017-01-01 120
Number of participants with account balances 2017-01-01 114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 11

Measure	Date	Value
2022: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	122
Number of retired or separated participants receiving benefits	2022-01-01	2
Number of other retired or separated participants entitled to future benefits	2022-01-01	34
Total of all active and inactive participants	2022-01-01	158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	1
Total participants	2022-01-01	159
Number of participants with account balances	2022-01-01	99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	2
2021: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	108
Number of other retired or separated participants entitled to future benefits	2021-01-01	29
Total of all active and inactive participants	2021-01-01	137
Total participants	2021-01-01	137
Number of participants with account balances	2021-01-01	137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	3
2020: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	93
Number of other retired or separated participants entitled to future benefits	2020-01-01	32
Total of all active and inactive participants	2020-01-01	125
Total participants	2020-01-01	125
Number of participants with account balances	2020-01-01	98
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	5
2019: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	96
Number of other retired or separated participants entitled to future benefits	2019-01-01	26
Total of all active and inactive participants	2019-01-01	122
Total participants	2019-01-01	122
Number of participants with account balances	2019-01-01	101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	4
2018: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	91
Number of other retired or separated participants entitled to future benefits	2018-01-01	33
Total of all active and inactive participants	2018-01-01	124
Total participants	2018-01-01	124
Number of participants with account balances	2018-01-01	108
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	7
2017: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	104
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	96
Number of other retired or separated participants entitled to future benefits	2017-01-01	24
Total of all active and inactive participants	2017-01-01	120
Total participants	2017-01-01	120
Number of participants with account balances	2017-01-01	114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	11

Financial Data on SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN

Measure	Date	Value
2022 : SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$-287,527
Total of all expenses incurred	2022-12-31	$79,413
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$79,085
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$482,357
Value of total assets at end of year	2022-12-31	$4,522,825
Value of total assets at beginning of year	2022-12-31	$4,889,765
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$328
Total interest from all sources	2022-12-31	$3,714
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
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	$224,636
Participant contributions at end of year	2022-12-31	$9,675
Participant contributions at beginning of year	2022-12-31	$11,166
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$96,840
Administrative expenses (other) incurred	2022-12-31	$328
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	$-366,940
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,522,825
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$4,889,765
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	$3,830,691
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$4,272,684
Interest earned on other investments	2022-12-31	$3,714
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$667,482
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$598,227
Net investment gain/loss from pooled separate accounts	2022-12-31	$-773,598
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	$160,881
Employer contributions (assets) at end of year	2022-12-31	$14,977
Employer contributions (assets) at beginning of year	2022-12-31	$7,688
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$79,085
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2022-12-31	No
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	KING, REINSCH, PROSSER & CO., L.L.P
Accountancy firm EIN	2022-12-31	420941961
2021 : SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2021 401k financial data
Total income from all sources (including contributions)	2021-12-31	$1,016,342
Total of all expenses incurred	2021-12-31	$703,632
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$703,087
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$390,712
Value of total assets at end of year	2021-12-31	$4,889,765
Value of total assets at beginning of year	2021-12-31	$4,577,055
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$545
Total interest from all sources	2021-12-31	$12,067
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
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
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$217,652
Participant contributions at end of year	2021-12-31	$11,166
Participant contributions at beginning of year	2021-12-31	$18,397
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$35,583
Administrative expenses (other) incurred	2021-12-31	$545
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	$312,710
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$4,889,765
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$4,577,055
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	$4,272,684
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$3,568,969
Interest earned on other investments	2021-12-31	$12,067
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$598,227
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$976,967
Net investment gain/loss from pooled separate accounts	2021-12-31	$613,563
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	$137,477
Employer contributions (assets) at end of year	2021-12-31	$7,688
Employer contributions (assets) at beginning of year	2021-12-31	$12,722
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$703,087
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	No
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	Unqualified
Accountancy firm name	2021-12-31	KING, REINSCH, PROSSER & CO., L.L.P
Accountancy firm EIN	2021-12-31	420941961
2020 : SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2020 401k financial data
Total income from all sources (including contributions)	2020-12-31	$870,277
Total of all expenses incurred	2020-12-31	$257,108
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$256,520
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$375,515
Value of total assets at end of year	2020-12-31	$4,577,055
Value of total assets at beginning of year	2020-12-31	$3,963,886
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$588
Total interest from all sources	2020-12-31	$16,784
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
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
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$210,376
Participant contributions at end of year	2020-12-31	$18,397
Participant contributions at beginning of year	2020-12-31	$9,329
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$60,956
Administrative expenses (other) incurred	2020-12-31	$588
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	$613,169
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$4,577,055
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$3,963,886
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	$3,568,969
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$2,894,787
Interest earned on other investments	2020-12-31	$16,784
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$976,967
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$1,059,770
Net investment gain/loss from pooled separate accounts	2020-12-31	$477,978
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	$104,183
Employer contributions (assets) at end of year	2020-12-31	$12,722
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$256,520
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-12-31	No
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	KING, REINSCH, PROSSER & CO., L.L.P
Accountancy firm EIN	2020-12-31	420941961
2019 : SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2019 401k financial data
Total income from all sources (including contributions)	2019-12-31	$940,226
Total of all expenses incurred	2019-12-31	$546,897
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$546,275
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$380,471
Value of total assets at end of year	2019-12-31	$3,963,886
Value of total assets at beginning of year	2019-12-31	$3,570,557
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$622
Total interest from all sources	2019-12-31	$19,637
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$400,000
If this is an individual account plan, was there a blackout period	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	$231,454
Participant contributions at end of year	2019-12-31	$9,329
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$2,470
Administrative expenses (other) incurred	2019-12-31	$622
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	$393,329
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,963,886
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$3,570,557
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	$2,894,787
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,510,787
Interest earned on other investments	2019-12-31	$19,637
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,059,770
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,059,770
Net investment gain/loss from pooled separate accounts	2019-12-31	$540,118
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	$146,547
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$546,275
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	No
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	KING, REINSCH, PROSSER & CO., L.L.P
Accountancy firm EIN	2019-12-31	420941961
2018 : SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2018 401k financial data
Total income from all sources (including contributions)	2018-12-31	$145,363
Total of all expenses incurred	2018-12-31	$138,893
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$137,960
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$330,639
Value of total assets at end of year	2018-12-31	$3,570,557
Value of total assets at beginning of year	2018-12-31	$3,564,087
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$933
Total interest from all sources	2018-12-31	$12,719
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$400,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$181,609
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$82,896
Administrative expenses (other) incurred	2018-12-31	$933
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$6,470
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$3,570,557
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$3,564,087
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$2,510,787
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$2,435,125
Interest earned on other investments	2018-12-31	$12,719
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$1,059,770
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$1,128,962
Net investment gain/loss from pooled separate accounts	2018-12-31	$-197,995
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$66,134
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$137,960
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	KING, REINSCH, PROSSER & CO., L.L.P
Accountancy firm EIN	2018-12-31	420941961
2017 : SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2017 401k financial data
Total income from all sources (including contributions)	2017-12-31	$953,172
Total of all expenses incurred	2017-12-31	$272,355
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$271,146
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$616,520
Value of total assets at end of year	2017-12-31	$3,564,087
Value of total assets at beginning of year	2017-12-31	$2,883,270
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$1,209
Total interest from all sources	2017-12-31	$13,271
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$300,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$170,451
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$246,825
Administrative expenses (other) incurred	2017-12-31	$1,209
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$680,817
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$3,564,087
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,883,270
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$2,435,125
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,825,047
Interest earned on other investments	2017-12-31	$13,271
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$1,128,962
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,058,223
Net investment gain/loss from pooled separate accounts	2017-12-31	$323,381
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$199,244
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$271,146
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	KING, REINSCH, PROSSER & CO., L.L.P
Accountancy firm EIN	2017-12-31	420941961

Form 5500 Responses for SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN

2022: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: SIOUXLAND MENTAL HEALTH SERVICES, INC. 403(B) THRIFT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	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

020269

Policy instance

Insurance contract or identification number	020269
Number of Individuals Covered	99
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $369
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	369
Additional information about fees paid to insurance broker	INCENTIVE COMPENSATION
Insurance broker organization code?	3

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

Policy contract number

020269-A

Policy instance

Insurance contract or identification number	020269-A
Number of Individuals Covered	95
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $632
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	632
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

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

Policy contract number

020269-A

Policy instance

Insurance contract or identification number	020269-A
Number of Individuals Covered	100
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $632
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	632
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

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

Policy contract number

020269-A

Policy instance

Insurance contract or identification number	020269-A
Number of Individuals Covered	101
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $885
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	885
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

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

Policy contract number

020269-A

Policy instance

Insurance contract or identification number	020269-A
Number of Individuals Covered	108
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $2,150
Contracts With Unallocated Funds Deposit Administration	1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	2150
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3

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

Policy contract number

020269-A

Policy instance

Insurance contract or identification number	020269-A
Number of Individuals Covered	114
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,637
Contracts With Unallocated Funds Deposit Administration	1
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1637
Additional information about fees paid to insurance broker	PORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?	3
Insurance broker name	MOA MINNEAPOLIS REGIONAL OFFICE

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Company Name:	SIOUXLAND MENTAL HEALTH SERVICES, INC.
Employer identification number (EIN):	426122297
NAIC Classification:	621330
NAIC Description:	Offices of Mental Health Practitioners (except Physicians)

Jurisdiction of Incorporation:	Iowa Secretary of State Business Entities
Incorporation Date:	1968-05-20
Company Identification Number:	063211
Legal Registered Office Address:	625 COURT ST SIOUX CITY United States of America (USA) 51101