401k Plan data: LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN plan

LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN 401k Plan overview

Plan Name	LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN
Plan identification number	506

LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance

401k Sponsoring company profile

LAKESHORE COMMUNITY SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: LAKESHORE COMMUNITY SERVICES, INC.

Employer identification number (EIN): 251577930

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2015-03-01 DONNA CARLINO
506 2015-03-01 DELIGHT STEVENS 2021-11-23
506 2013-03-13 RICHARD RUEDY RICHARD RUEDY 2014-07-25

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
506	2015-03-01	DONNA CARLINO
506	2015-03-01	DELIGHT STEVENS	2021-11-23
506	2013-03-13	RICHARD RUEDY		RICHARD RUEDY	2014-07-25

Plan Statistics for LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN

401k plan membership statisitcs for LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN

Measure Date Value
2015: LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-03-01 318
Total number of active participants reported on line 7a of the Form 5500 2015-03-01 318
Total of all active and inactive participants 2015-03-01 318
Total participants 2015-03-01 318
Number of retired or separated participants receiving benefits 2015-03-01 0
Number of other retired or separated participants entitled to future benefits 2015-03-01 0
2013: LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-03-13 308
Total number of active participants reported on line 7a of the Form 5500 2013-03-13 308
Total of all active and inactive participants 2013-03-13 308
Total participants 2013-03-13 308

Measure	Date	Value
2015: LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-03-01	318
Total number of active participants reported on line 7a of the Form 5500	2015-03-01	318
Total of all active and inactive participants	2015-03-01	318
Total participants	2015-03-01	318
Number of retired or separated participants receiving benefits	2015-03-01	0
Number of other retired or separated participants entitled to future benefits	2015-03-01	0
2013: LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-03-13	308
Total number of active participants reported on line 7a of the Form 5500	2013-03-13	308
Total of all active and inactive participants	2013-03-13	308
Total participants	2013-03-13	308

Form 5500 Responses for LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN

2015: LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN 2015 form 5500 responses
2015-03-01	Type of plan entity	Single employer plan
2015-03-01	Submission has been amended	No
2015-03-01	This submission is the final filing	No
2015-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-03-01	Plan is a collectively bargained plan	No
2015-03-01	Plan funding arrangement – Insurance	Yes
2015-03-01	Plan benefit arrangement – Insurance	Yes
2013: LAKESHORE COMMUNITY SERVICES, INC GROUP LIFE PLAN 2013 form 5500 responses
2013-03-13	Type of plan entity	Single employer plan
2013-03-13	Submission has been amended	No
2013-03-13	This submission is the final filing	No
2013-03-13	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-03-13	Plan is a collectively bargained plan	No
2013-03-13	Plan funding arrangement – Insurance	Yes
2013-03-13	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

P00686

Policy instance

Insurance contract or identification number	P00686
Number of Individuals Covered	0
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $1,239
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
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?	Yes
Commission paid to Insurance Broker	USD $1,239
Insurance broker organization code?	3

Potentially related plans

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Company Name:	LAKESHORE COMMUNITY SERVICES, INC.
Employer identification number (EIN):	251577930
NAIC Classification:	624100
NAIC Description:	Individual and Family Services