401k Plan data: LAKESIDE SURFACES 401(K) PLAN plan

LAKESIDE SURFACES 401(K) PLAN 401k Plan overview

Plan Name	LAKESIDE SURFACES 401(K) PLAN
Plan identification number	001

LAKESIDE SURFACES 401(K) PLAN 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.
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

LAKESIDE SURFACES, LLC has sponsored the creation of one or more 401k plans.

Company Name: LAKESIDE SURFACES, LLC

Employer identification number (EIN): 383594873

NAIC Classification: 444190
NAIC Description: Other Building Material Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKESIDE SURFACES 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 DANIEL FOY
001 2016-01-01 DANIEL FOY 2017-04-26
001 2015-01-01 DANIEL FOY 2016-05-16

Plan Statistics for LAKESIDE SURFACES 401(K) PLAN

401k plan membership statisitcs for LAKESIDE SURFACES 401(K) PLAN

Measure Date Value
2023: LAKESIDE SURFACES 401(K) PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 120
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 77
Total of all active and inactive participants 2023-01-01 197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 197
Number of participants with account balances 2023-01-01 192
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 30
2022: LAKESIDE SURFACES 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 211
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 139
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 77
Total of all active and inactive participants 2022-01-01 216
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 216
Number of participants with account balances 2022-01-01 204
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 30
2021: LAKESIDE SURFACES 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 138
Number of retired or separated participants receiving benefits 2021-01-01 1
Number of other retired or separated participants entitled to future benefits 2021-01-01 67
Total of all active and inactive participants 2021-01-01 206
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 206
Number of participants with account balances 2021-01-01 192
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: LAKESIDE SURFACES 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 118
Number of retired or separated participants receiving benefits 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 44
Total of all active and inactive participants 2020-01-01 163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 163
Number of participants with account balances 2020-01-01 146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 18
2019: LAKESIDE SURFACES 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 147
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 111
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 34
Total of all active and inactive participants 2019-01-01 146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 146
Number of participants with account balances 2019-01-01 124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 15
2018: LAKESIDE SURFACES 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 114
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 28
Total of all active and inactive participants 2018-01-01 143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 143
Number of participants with account balances 2018-01-01 128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 29
2017: LAKESIDE SURFACES 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 133
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 16
Total of all active and inactive participants 2017-01-01 149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 149
Number of participants with account balances 2017-01-01 133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 20

Measure	Date	Value
2023: LAKESIDE SURFACES 401(K) PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	120
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	77
Total of all active and inactive participants	2023-01-01	197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	197
Number of participants with account balances	2023-01-01	192
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	30
2022: LAKESIDE SURFACES 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	211
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	139
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	77
Total of all active and inactive participants	2022-01-01	216
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	216
Number of participants with account balances	2022-01-01	204
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	30
2021: LAKESIDE SURFACES 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	138
Number of retired or separated participants receiving benefits	2021-01-01	1
Number of other retired or separated participants entitled to future benefits	2021-01-01	67
Total of all active and inactive participants	2021-01-01	206
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	206
Number of participants with account balances	2021-01-01	192
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: LAKESIDE SURFACES 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	118
Number of retired or separated participants receiving benefits	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	44
Total of all active and inactive participants	2020-01-01	163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	163
Number of participants with account balances	2020-01-01	146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	18
2019: LAKESIDE SURFACES 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	147
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	111
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	34
Total of all active and inactive participants	2019-01-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	146
Number of participants with account balances	2019-01-01	124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	15
2018: LAKESIDE SURFACES 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	114
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	28
Total of all active and inactive participants	2018-01-01	143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	143
Number of participants with account balances	2018-01-01	128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	29
2017: LAKESIDE SURFACES 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	133
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	16
Total of all active and inactive participants	2017-01-01	149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	149
Number of participants with account balances	2017-01-01	133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	20

Financial Data on LAKESIDE SURFACES 401(K) PLAN

Measure	Date	Value
2023 : LAKESIDE SURFACES 401(K) PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total income from all sources (including contributions)	2023-12-31	$1,248,507
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$567,315
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$523,573
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$683,882
Value of total assets at end of year	2023-12-31	$3,467,513
Value of total assets at beginning of year	2023-12-31	$2,786,321
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$43,742
Total interest from all sources	2023-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$564,625
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2023-12-31	$564,625
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$290,586
If this is an individual account plan, was there a blackout period	2023-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-12-31	No
Contributions received from participants	2023-12-31	$467,476
Participant contributions at end of year	2023-12-31	$0
Participant contributions at beginning of year	2023-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$36,487
Total non interest bearing cash at end of year	2023-12-31	$10,626
Total non interest bearing cash at beginning of year	2023-12-31	$21,943
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Value of net income/loss	2023-12-31	$681,192
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$3,467,513
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$2,786,321
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-12-31	No
Were any leases to which the plan was party in default or uncollectible	2023-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-12-31	$3,456,887
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-12-31	$2,764,378
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-12-31	No
Was there a failure to transmit to the plan any participant contributions	2023-12-31	No
Has the plan failed to provide any benefit when due under the plan	2023-12-31	No
Contributions received in cash from employer	2023-12-31	$179,919
Employer contributions (assets) at end of year	2023-12-31	$0
Employer contributions (assets) at beginning of year	2023-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$523,573
Contract administrator fees	2023-12-31	$43,742
Did the plan have assets held for investment	2023-12-31	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	2023-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-12-31	No
Opinion of an independent qualified public accountant for this plan	2023-12-31	Unqualified
Accountancy firm name	2023-12-31	MEYAARD TOLMAN & VENLET P.C.
Accountancy firm EIN	2023-12-31	382598193
2022 : LAKESIDE SURFACES 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$184,875
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$304,411
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$278,633
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$713,540
Value of total assets at end of year	2022-12-31	$2,786,321
Value of total assets at beginning of year	2022-12-31	$2,905,857
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$25,778
Total interest from all sources	2022-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$-528,665
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$-528,665
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$290,586
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	$412,717
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$97,386
Total non interest bearing cash at end of year	2022-12-31	$21,943
Total non interest bearing cash at beginning of year	2022-12-31	$12,048
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	$-119,536
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$2,786,321
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$2,905,857
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
Investment advisory and management fees	2022-12-31	$25,778
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$2,764,378
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$2,893,809
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	$203,437
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$278,633
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	MEYAARD TOLMAN & VENLET P.C.
Accountancy firm EIN	2022-12-31	382598193
2021 : LAKESIDE SURFACES 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$984,036
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$200,102
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$175,695
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$609,575
Value of total assets at end of year	2021-12-31	$2,905,857
Value of total assets at beginning of year	2021-12-31	$2,121,923
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$24,407
Total interest from all sources	2021-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$374,461
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$374,461
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$250,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$352,203
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$82,191
Total non interest bearing cash at end of year	2021-12-31	$12,048
Total non interest bearing cash at beginning of year	2021-12-31	$8,169
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	$783,934
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$2,905,857
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$2,121,923
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	$2,893,809
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$2,113,754
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	$175,181
Employer contributions (assets) at end of year	2021-12-31	$0
Employer contributions (assets) at beginning of year	2021-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$175,695
Contract administrator fees	2021-12-31	$24,407
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	MEYAARD TOLMAN & VENLET P.C.
Accountancy firm EIN	2021-12-31	382598193
2020 : LAKESIDE SURFACES 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$779,828
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$275,499
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$258,777
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$489,945
Value of total assets at end of year	2020-12-31	$2,121,923
Value of total assets at beginning of year	2020-12-31	$1,617,594
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$16,722
Total interest from all sources	2020-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$289,883
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$289,883
Administrative expenses professional fees incurred	2020-12-31	$16,722
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$250,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$308,568
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$31,545
Total non interest bearing cash at end of year	2020-12-31	$8,169
Total non interest bearing cash at beginning of year	2020-12-31	$3,254
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	$504,329
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$2,121,923
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$1,617,594
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$2,113,754
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,614,340
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	$149,832
Employer contributions (assets) at end of year	2020-12-31	$0
Employer contributions (assets) at beginning of year	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$258,777
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	MEYAARD TOLMAN & VENLET P.C.
Accountancy firm EIN	2020-12-31	382598193
2019 : LAKESIDE SURFACES 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$643,980
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$145,211
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$132,922
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$388,855
Value of total assets at end of year	2019-12-31	$1,617,594
Value of total assets at beginning of year	2019-12-31	$1,118,825
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$12,289
Total interest from all sources	2019-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$255,125
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$255,125
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$250,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$263,911
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$12,324
Total non interest bearing cash at end of year	2019-12-31	$3,254
Total non interest bearing cash at beginning of year	2019-12-31	$385
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	$498,769
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$1,617,594
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$1,118,825
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
Investment advisory and management fees	2019-12-31	$5,689
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,614,340
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$1,102,208
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	$124,944
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$3,908
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$132,922
Contract administrator fees	2019-12-31	$6,600
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	MEYAARD TOLMAN & VENLET P.C.
Accountancy firm EIN	2019-12-31	382598193
2018 : LAKESIDE SURFACES 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$322,898
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$101,204
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$98,379
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$393,276
Value of total assets at end of year	2018-12-31	$1,118,825
Value of total assets at beginning of year	2018-12-31	$897,131
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$2,825
Total interest from all sources	2018-12-31	$-70,378
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$2,825
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$250,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$285,465
Participant contributions at end of year	2018-12-31	$12,324
Participant contributions at beginning of year	2018-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$931
Total non interest bearing cash at end of year	2018-12-31	$385
Total non interest bearing cash at beginning of year	2018-12-31	$14,887
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	$221,694
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,118,825
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$897,131
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	$1,102,208
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$882,244
Interest earned on other investments	2018-12-31	$-70,378
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	$106,880
Employer contributions (assets) at end of year	2018-12-31	$3,908
Employer contributions (assets) at beginning of year	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$98,379
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	MEYAARD TOLMAN & VENLET P.C.
Accountancy firm EIN	2018-12-31	382598193
2017 : LAKESIDE SURFACES 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$557,296
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$56,022
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$54,272
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$443,524
Value of total assets at end of year	2017-12-31	$897,131
Value of total assets at beginning of year	2017-12-31	$395,857
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$1,750
Total interest from all sources	2017-12-31	$113,772
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$1,750
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$250,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$284,137
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$22,561
Total non interest bearing cash at end of year	2017-12-31	$14,887
Total non interest bearing cash at beginning of year	2017-12-31	$2,456
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	$501,274
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$897,131
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$395,857
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	$882,244
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$393,401
Interest earned on other investments	2017-12-31	$113,772
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	$136,826
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$54,272
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	MEYAARD TOLMAN & VENLET P.C.
Accountancy firm EIN	2017-12-31	382598193

Form 5500 Responses for LAKESIDE SURFACES 401(K) PLAN

2023: LAKESIDE SURFACES 401(K) PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: LAKESIDE SURFACES 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: LAKESIDE SURFACES 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: LAKESIDE SURFACES 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: LAKESIDE SURFACES 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: LAKESIDE SURFACES 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: LAKESIDE SURFACES 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

513334-000

Policy instance

Insurance contract or identification number	513334-000
Number of Individuals Covered	120
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,569
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

513334-000

Policy instance

Insurance contract or identification number	513334-000
Number of Individuals Covered	211
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 $1,343
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1343
Additional information about fees paid to insurance broker	0
Insurance broker organization code?	5

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

513334-000

Policy instance

Insurance contract or identification number	513334-000
Number of Individuals Covered	0
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 $1,293
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	1293
Additional information about fees paid to insurance broker	0
Insurance broker organization code?	5

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

513334-000

Policy instance

Insurance contract or identification number	513334-000
Number of Individuals Covered	146
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 $891
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	891
Additional information about fees paid to insurance broker	0
Insurance broker organization code?	5

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

513334-000

Policy instance

Insurance contract or identification number	513334-000
Number of Individuals Covered	146
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 $2,936
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	2936
Additional information about fees paid to insurance broker	0
Insurance broker organization code?	5

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Company Name:	LAKESIDE SURFACES, LLC
Employer identification number (EIN):	383594873
NAIC Classification:	444190
NAIC Description:	Other Building Material Dealers