401k Plan data: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER plan

EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 401k Plan overview

Plan Name	EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER
Plan identification number	001

EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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

MIDWESTERN COLORADO MENTAL HEALTH CENTER has sponsored the creation of one or more 401k plans.

Company Name: MIDWESTERN COLORADO MENTAL HEALTH CENTER

Employer identification number (EIN): 840561224

NAIC Classification: 621420
NAIC Description: Outpatient Mental Health and Substance Abuse Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-07-01
001 2021-07-01
001 2020-07-01
001 2019-07-01
001 2018-07-01
001 2018-07-01
001 2017-07-01
001 2016-07-01 LANCE E. LEHIGH 2018-04-10 LANCE E. LEHIGH 2018-04-10
001 2015-07-01 LANCE E. LEHIGH 2017-04-17 LANCE E. LEHIGH 2017-04-17
001 2014-07-01 LANCE E. LEHIGH 2016-04-15 LANCE E. LEHIGH 2016-04-15
001 2013-07-01 LANCE LEHIGH 2015-01-30 LANCE LEHIGH 2015-01-30
001 2012-07-01 LANCE E. LEHIGH 2014-01-30
001 2011-07-01 LANCE E. LEHIGH 2013-04-12 LANCE E. LEHIGH 2013-04-12
001 2010-07-01 TOM R. MRAULE 2012-01-27 TOM R. MRAULE 2012-01-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-07-01
001	2021-07-01
001	2020-07-01
001	2019-07-01
001	2018-07-01
001	2018-07-01
001	2017-07-01
001	2016-07-01	LANCE E. LEHIGH	2018-04-10	LANCE E. LEHIGH	2018-04-10
001	2015-07-01	LANCE E. LEHIGH	2017-04-17	LANCE E. LEHIGH	2017-04-17
001	2014-07-01	LANCE E. LEHIGH	2016-04-15	LANCE E. LEHIGH	2016-04-15
001	2013-07-01	LANCE LEHIGH	2015-01-30	LANCE LEHIGH	2015-01-30
001	2012-07-01	LANCE E. LEHIGH	2014-01-30
001	2011-07-01	LANCE E. LEHIGH	2013-04-12	LANCE E. LEHIGH	2013-04-12
001	2010-07-01	TOM R. MRAULE	2012-01-27	TOM R. MRAULE	2012-01-27

Plan Statistics for EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER

401k plan membership statisitcs for EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER

Measure Date Value
2021: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2021 401k membership
Total participants, beginning-of-year 2021-07-01 222
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 3
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-07-01 0
Total participants 2021-07-01 3
Number of participants with account balances 2021-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-07-01 0
2020: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2020 401k membership
Total participants, beginning-of-year 2020-07-01 219
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 128
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 89
Total of all active and inactive participants 2020-07-01 217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-07-01 0
Total participants 2020-07-01 217
Number of participants with account balances 2020-07-01 165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-07-01 18
2019: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2019 401k membership
Total participants, beginning-of-year 2019-07-01 172
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 124
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 88
Total of all active and inactive participants 2019-07-01 212
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-07-01 0
Total participants 2019-07-01 212
Number of participants with account balances 2019-07-01 156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-07-01 102
2018: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2018 401k membership
Total participants, beginning-of-year 2018-07-01 152
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 101
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 65
Total of all active and inactive participants 2018-07-01 166
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-07-01 0
Total participants 2018-07-01 166
Number of participants with account balances 2018-07-01 158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-07-01 6
2017: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2017 401k membership
Total participants, beginning-of-year 2017-07-01 144
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 105
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 46
Total of all active and inactive participants 2017-07-01 151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-07-01 1
Total participants 2017-07-01 152
Number of participants with account balances 2017-07-01 145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-07-01 13

Measure	Date	Value
2021: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2021 401k membership
Total participants, beginning-of-year	2021-07-01	222
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	3
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-07-01	0
Total participants	2021-07-01	3
Number of participants with account balances	2021-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-07-01	0
2020: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2020 401k membership
Total participants, beginning-of-year	2020-07-01	219
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	128
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	89
Total of all active and inactive participants	2020-07-01	217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-07-01	0
Total participants	2020-07-01	217
Number of participants with account balances	2020-07-01	165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-07-01	18
2019: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2019 401k membership
Total participants, beginning-of-year	2019-07-01	172
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	124
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	88
Total of all active and inactive participants	2019-07-01	212
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-07-01	0
Total participants	2019-07-01	212
Number of participants with account balances	2019-07-01	156
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-07-01	102
2018: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2018 401k membership
Total participants, beginning-of-year	2018-07-01	152
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	101
Number of retired or separated participants receiving benefits	2018-07-01	0
Number of other retired or separated participants entitled to future benefits	2018-07-01	65
Total of all active and inactive participants	2018-07-01	166
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-07-01	0
Total participants	2018-07-01	166
Number of participants with account balances	2018-07-01	158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-07-01	6
2017: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2017 401k membership
Total participants, beginning-of-year	2017-07-01	144
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	105
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	46
Total of all active and inactive participants	2017-07-01	151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-07-01	1
Total participants	2017-07-01	152
Number of participants with account balances	2017-07-01	145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-07-01	13

Financial Data on EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER

Measure	Date	Value
2022 : EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-06-30	$0
Total transfer of assets from this plan	2022-06-30	$5,961,395
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-06-30	$0
Total income from all sources (including contributions)	2022-06-30	$-204,612
Total loss/gain on sale of assets	2022-06-30	$0
Total of all expenses incurred	2022-06-30	$291,522
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-06-30	$230,873
Value of total corrective distributions	2022-06-30	$8,808
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-06-30	$730,834
Value of total assets at end of year	2022-06-30	$43,953
Value of total assets at beginning of year	2022-06-30	$6,501,482
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-06-30	$51,841
Total interest from all sources	2022-06-30	$766
Total dividends received (eg from common stock, registered investment company shares)	2022-06-30	$88,022
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-06-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2022-06-30	$0
Total dividends received from registered investment company shares (eg mutual funds)	2022-06-30	$88,022
Was this plan covered by a fidelity bond	2022-06-30	Yes
Value of fidelity bond cover	2022-06-30	$500,000
If this is an individual account plan, was there a blackout period	2022-06-30	Yes
Were there any nonexempt tranactions with any party-in-interest	2022-06-30	No
Contributions received from participants	2022-06-30	$486,559
Participant contributions at end of year	2022-06-30	$17,250
Participant contributions at beginning of year	2022-06-30	$29,625
Participant contributions at end of year	2022-06-30	$18,335
Participant contributions at beginning of year	2022-06-30	$17,436
Income. Received or receivable in cash from other sources (including rollovers)	2022-06-30	$42,802
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-06-30	No
Value of net income/loss	2022-06-30	$-496,134
Value of net assets at end of year (total assets less liabilities)	2022-06-30	$43,953
Value of net assets at beginning of year (total assets less liabilities)	2022-06-30	$6,501,482
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-06-30	No
Were any leases to which the plan was party in default or uncollectible	2022-06-30	No
Investment advisory and management fees	2022-06-30	$32,967
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-06-30	$181
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-06-30	$6,098,795
Interest on participant loans	2022-06-30	$766
Income. Interest from loans (other than to participants)	2022-06-30	$0
Value of interest in common/collective trusts at end of year	2022-06-30	$0
Value of interest in common/collective trusts at beginning of year	2022-06-30	$343,419
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-06-30	$-1,034,098
Net investment gain or loss from common/collective trusts	2022-06-30	$9,864
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-06-30	No
Was there a failure to transmit to the plan any participant contributions	2022-06-30	No
Has the plan failed to provide any benefit when due under the plan	2022-06-30	No
Contributions received in cash from employer	2022-06-30	$201,473
Employer contributions (assets) at end of year	2022-06-30	$8,187
Employer contributions (assets) at beginning of year	2022-06-30	$12,207
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-06-30	$230,873
Contract administrator fees	2022-06-30	$18,874
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	2022-06-30	Yes
Did the plan have assets held for investment	2022-06-30	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	2022-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-06-30	No
Opinion of an independent qualified public accountant for this plan	2022-06-30	Unqualified
Accountancy firm name	2022-06-30	DALBY, WENDLAND & CO., P.C.
Accountancy firm EIN	2022-06-30	840795096
2021 : EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$0
Total income from all sources (including contributions)	2021-06-30	$2,247,439
Total loss/gain on sale of assets	2021-06-30	$0
Total of all expenses incurred	2021-06-30	$1,019,000
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-06-30	$978,968
Value of total corrective distributions	2021-06-30	$900
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-06-30	$688,390
Value of total assets at end of year	2021-06-30	$6,501,482
Value of total assets at beginning of year	2021-06-30	$5,273,043
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-06-30	$39,132
Total interest from all sources	2021-06-30	$1,906
Total dividends received (eg from common stock, registered investment company shares)	2021-06-30	$79,227
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-06-30	$79,227
Was this plan covered by a fidelity bond	2021-06-30	Yes
Value of fidelity bond cover	2021-06-30	$500,000
If this is an individual account plan, was there a blackout period	2021-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2021-06-30	No
Contributions received from participants	2021-06-30	$405,244
Participant contributions at end of year	2021-06-30	$29,625
Participant contributions at beginning of year	2021-06-30	$53,025
Participant contributions at end of year	2021-06-30	$17,436
Participant contributions at beginning of year	2021-06-30	$12,937
Income. Received or receivable in cash from other sources (including rollovers)	2021-06-30	$97,289
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-06-30	No
Value of net income/loss	2021-06-30	$1,228,439
Value of net assets at end of year (total assets less liabilities)	2021-06-30	$6,501,482
Value of net assets at beginning of year (total assets less liabilities)	2021-06-30	$5,273,043
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-06-30	No
Were any leases to which the plan was party in default or uncollectible	2021-06-30	No
Investment advisory and management fees	2021-06-30	$21,980
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-06-30	$6,098,795
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-06-30	$4,926,448
Interest on participant loans	2021-06-30	$1,906
Income. Interest from loans (other than to participants)	2021-06-30	$0
Value of interest in common/collective trusts at end of year	2021-06-30	$343,419
Value of interest in common/collective trusts at beginning of year	2021-06-30	$273,608
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-06-30	$802
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-06-30	$802
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-06-30	$1,470,298
Net investment gain or loss from common/collective trusts	2021-06-30	$7,618
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-06-30	No
Was there a failure to transmit to the plan any participant contributions	2021-06-30	Yes
Has the plan failed to provide any benefit when due under the plan	2021-06-30	No
Contributions received in cash from employer	2021-06-30	$185,857
Employer contributions (assets) at end of year	2021-06-30	$12,207
Employer contributions (assets) at beginning of year	2021-06-30	$6,223
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-06-30	$978,968
Contract administrator fees	2021-06-30	$17,152
Did the plan have assets held for investment	2021-06-30	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	2021-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-06-30	No
Opinion of an independent qualified public accountant for this plan	2021-06-30	Disclaimer
Accountancy firm name	2021-06-30	DALBY WENDLAND & CO PC
Accountancy firm EIN	2021-06-30	840795096
2020 : EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$0
Total income from all sources (including contributions)	2020-06-30	$682,184
Total loss/gain on sale of assets	2020-06-30	$0
Total of all expenses incurred	2020-06-30	$1,467,228
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-06-30	$1,450,677
Expenses. Certain deemed distributions of participant loans	2020-06-30	$14,681
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-06-30	$638,980
Value of total assets at end of year	2020-06-30	$5,273,043
Value of total assets at beginning of year	2020-06-30	$6,058,087
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-06-30	$1,870
Total interest from all sources	2020-06-30	$4,315
Total dividends received (eg from common stock, registered investment company shares)	2020-06-30	$6,158
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-06-30	$6,158
Was this plan covered by a fidelity bond	2020-06-30	Yes
Value of fidelity bond cover	2020-06-30	$500,000
If this is an individual account plan, was there a blackout period	2020-06-30	Yes
Were there any nonexempt tranactions with any party-in-interest	2020-06-30	No
Contributions received from participants	2020-06-30	$319,331
Participant contributions at end of year	2020-06-30	$53,025
Participant contributions at beginning of year	2020-06-30	$54,998
Participant contributions at end of year	2020-06-30	$12,937
Participant contributions at beginning of year	2020-06-30	$11,963
Income. Received or receivable in cash from other sources (including rollovers)	2020-06-30	$149,969
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Value of net income/loss	2020-06-30	$-785,044
Value of net assets at end of year (total assets less liabilities)	2020-06-30	$5,273,043
Value of net assets at beginning of year (total assets less liabilities)	2020-06-30	$6,058,087
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-06-30	No
Were any leases to which the plan was party in default or uncollectible	2020-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-06-30	$4,926,448
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-06-30	$5,716,404
Interest on participant loans	2020-06-30	$3,513
Income. Interest from loans (other than to participants)	2020-06-30	$0
Value of interest in common/collective trusts at end of year	2020-06-30	$273,608
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-06-30	$802
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-06-30	$802
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-06-30	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-06-30	$268,029
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-06-30	$382,067
Net investment gain/loss from pooled separate accounts	2020-06-30	$-350,079
Net investment gain or loss from common/collective trusts	2020-06-30	$743
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-06-30	No
Was there a failure to transmit to the plan any participant contributions	2020-06-30	No
Has the plan failed to provide any benefit when due under the plan	2020-06-30	No
Contributions received in cash from employer	2020-06-30	$169,680
Employer contributions (assets) at end of year	2020-06-30	$6,223
Employer contributions (assets) at beginning of year	2020-06-30	$6,693
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-06-30	$1,450,677
Contract administrator fees	2020-06-30	$1,870
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	2020-06-30	Yes
Did the plan have assets held for investment	2020-06-30	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	2020-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-06-30	No
Opinion of an independent qualified public accountant for this plan	2020-06-30	Unqualified
Accountancy firm name	2020-06-30	DALBY, WENDLAND & CO., P.C.
Accountancy firm EIN	2020-06-30	840795096
2019 : EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$0
Total income from all sources (including contributions)	2019-06-30	$893,542
Total loss/gain on sale of assets	2019-06-30	$0
Total of all expenses incurred	2019-06-30	$339,103
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-06-30	$321,824
Expenses. Certain deemed distributions of participant loans	2019-06-30	$16,230
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-06-30	$603,088
Value of total assets at end of year	2019-06-30	$6,058,087
Value of total assets at beginning of year	2019-06-30	$5,503,648
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-06-30	$1,049
Total interest from all sources	2019-06-30	$5,990
Total dividends received (eg from common stock, registered investment company shares)	2019-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-06-30	No
Was this plan covered by a fidelity bond	2019-06-30	Yes
Value of fidelity bond cover	2019-06-30	$500,000
If this is an individual account plan, was there a blackout period	2019-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2019-06-30	No
Contributions received from participants	2019-06-30	$330,338
Participant contributions at end of year	2019-06-30	$54,998
Participant contributions at beginning of year	2019-06-30	$69,012
Participant contributions at end of year	2019-06-30	$11,963
Participant contributions at beginning of year	2019-06-30	$16,429
Income. Received or receivable in cash from other sources (including rollovers)	2019-06-30	$127,710
Other income not declared elsewhere	2019-06-30	$0
Administrative expenses (other) incurred	2019-06-30	$1,049
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-06-30	No
Value of net income/loss	2019-06-30	$554,439
Value of net assets at end of year (total assets less liabilities)	2019-06-30	$6,058,087
Value of net assets at beginning of year (total assets less liabilities)	2019-06-30	$5,503,648
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-06-30	No
Were any leases to which the plan was party in default or uncollectible	2019-06-30	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-06-30	$5,716,404
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-06-30	$5,138,602
Interest on participant loans	2019-06-30	$2,374
Interest earned on other investments	2019-06-30	$3,616
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-06-30	$268,029
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-06-30	$270,049
Expenses. Payments to insurance carriers foe the provision of benefits	2019-06-30	$0
Net investment gain/loss from pooled separate accounts	2019-06-30	$284,464
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-06-30	No
Was there a failure to transmit to the plan any participant contributions	2019-06-30	No
Has the plan failed to provide any benefit when due under the plan	2019-06-30	No
Contributions received in cash from employer	2019-06-30	$145,040
Employer contributions (assets) at end of year	2019-06-30	$6,693
Employer contributions (assets) at beginning of year	2019-06-30	$9,556
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-06-30	$321,824
Did the plan have assets held for investment	2019-06-30	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	2019-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-06-30	No
Opinion of an independent qualified public accountant for this plan	2019-06-30	Unqualified
Accountancy firm name	2019-06-30	DALBY, WENDLAND & CO., P.C.
Accountancy firm EIN	2019-06-30	840795096
2018 : EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$0
Total income from all sources (including contributions)	2018-06-30	$1,298,233
Total loss/gain on sale of assets	2018-06-30	$0
Total of all expenses incurred	2018-06-30	$490,000
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-06-30	$488,826
Expenses. Certain deemed distributions of participant loans	2018-06-30	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-06-30	$851,768
Value of total assets at end of year	2018-06-30	$5,503,648
Value of total assets at beginning of year	2018-06-30	$4,695,415
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-06-30	$1,174
Total interest from all sources	2018-06-30	$5,545
Total dividends received (eg from common stock, registered investment company shares)	2018-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-06-30	No
Was this plan covered by a fidelity bond	2018-06-30	Yes
Value of fidelity bond cover	2018-06-30	$500,000
If this is an individual account plan, was there a blackout period	2018-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2018-06-30	No
Contributions received from participants	2018-06-30	$387,680
Participant contributions at end of year	2018-06-30	$69,012
Participant contributions at beginning of year	2018-06-30	$61,149
Participant contributions at end of year	2018-06-30	$16,429
Participant contributions at beginning of year	2018-06-30	$13,096
Income. Received or receivable in cash from other sources (including rollovers)	2018-06-30	$268,662
Other income not declared elsewhere	2018-06-30	$0
Administrative expenses (other) incurred	2018-06-30	$1,174
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-06-30	No
Value of net income/loss	2018-06-30	$808,233
Value of net assets at end of year (total assets less liabilities)	2018-06-30	$5,503,648
Value of net assets at beginning of year (total assets less liabilities)	2018-06-30	$4,695,415
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-06-30	No
Were any leases to which the plan was party in default or uncollectible	2018-06-30	No
Value of interest in pooled separate accounts at end of year	2018-06-30	$5,138,602
Value of interest in pooled separate accounts at beginning of year	2018-06-30	$4,340,141
Interest on participant loans	2018-06-30	$2,769
Interest earned on other investments	2018-06-30	$2,776
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-06-30	$270,049
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-06-30	$273,215
Expenses. Payments to insurance carriers foe the provision of benefits	2018-06-30	$0
Net investment gain/loss from pooled separate accounts	2018-06-30	$440,920
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-06-30	No
Was there a failure to transmit to the plan any participant contributions	2018-06-30	No
Has the plan failed to provide any benefit when due under the plan	2018-06-30	No
Contributions received in cash from employer	2018-06-30	$195,426
Employer contributions (assets) at end of year	2018-06-30	$9,556
Employer contributions (assets) at beginning of year	2018-06-30	$7,814
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-06-30	$488,826
Did the plan have assets held for investment	2018-06-30	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	2018-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-06-30	No
Opinion of an independent qualified public accountant for this plan	2018-06-30	Unqualified
Accountancy firm name	2018-06-30	DALBY WENDLAND
Accountancy firm EIN	2018-06-30	840795096

Form 5500 Responses for EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER

2021: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Submission has been amended	No
2021-07-01	This submission is the final filing	No
2021-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-07-01	Plan is a collectively bargained plan	No
2021-07-01	Plan funding arrangement – Trust	Yes
2021-07-01	Plan benefit arrangement - Trust	Yes
2020: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Submission has been amended	No
2020-07-01	This submission is the final filing	No
2020-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-07-01	Plan is a collectively bargained plan	No
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan funding arrangement – Trust	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement - Trust	Yes
2019: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – Trust	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement - Trust	Yes
2018: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Submission has been amended	Yes
2018-07-01	This submission is the final filing	No
2018-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-07-01	Plan is a collectively bargained plan	No
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: EMPLOYEE BENEFIT PLAN OF MIDWESTERN COLORADO MENTAL HEALTH CENTER 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Submission has been amended	No
2017-07-01	This submission is the final filing	No
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-07-01	Plan is a collectively bargained plan	No
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	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

056245-B

Policy instance

Insurance contract or identification number	056245-B
Number of Individuals Covered	0
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $0
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	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

056245-B

Policy instance

Insurance contract or identification number	056245-B
Number of Individuals Covered	0
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $989
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	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
Amount paid for insurance broker fees	989
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

056245B

Policy instance

Insurance contract or identification number	056245B
Number of Individuals Covered	166
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,729
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	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
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1729
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

056245B

Policy instance

Insurance contract or identification number	056245B
Number of Individuals Covered	152
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,165
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	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:	MIDWESTERN COLORADO MENTAL HEALTH CENTER
Employer identification number (EIN):	840561224
NAIC Classification:	621420
NAIC Description:	Outpatient Mental Health and Substance Abuse Centers