401k Plan data: LAKEVIEW INDUSTRIES, INC 401(K) PLAN plan

LAKEVIEW INDUSTRIES, INC 401(K) PLAN 401k Plan overview

Plan Name	LAKEVIEW INDUSTRIES, INC 401(K) PLAN
Plan identification number	002

LAKEVIEW INDUSTRIES, INC 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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

LAKEVIEW INDUSTRIES, INC has sponsored the creation of one or more 401k plans.

Company Name: LAKEVIEW INDUSTRIES, INC

Employer identification number (EIN): 411427378

NAIC Classification: 326200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKEVIEW INDUSTRIES, INC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2023-01-01 BREANNA STACK 2024-10-09
002 2022-01-01 BREANNA STACK 2023-10-12
002 2021-01-01
002 2020-01-01 BREANNA L STACK 2021-07-14 BREANNA L STACK 2021-07-14
002 2019-01-01
002 2018-01-01 BREANNA STACK 2019-09-13
002 2017-01-01 NATASSJA GOETTSCH 2018-05-09
002 2016-01-01 PHILIP ANDERSEN 2017-07-27 PHILIP ANDERSEN 2017-07-27
002 2015-01-01 PHILIP ANDERSEN 2016-06-06
002 2014-01-01 NATASSJA ELLIOTT 2015-06-23
002 2013-01-01 PHILIP ANDERSEN 2014-05-16
002 2012-01-01 PHILIP ANDERSEN 2013-05-21
002 2011-01-01 PHILIP ANDERSEN 2012-06-27 PHILIP ANDERSEN 2012-06-27
002 2010-01-01 JEFF MAGNUSON 2011-06-01 JEFF MAGNUSON 2011-06-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2023-01-01	BREANNA STACK	2024-10-09
002	2022-01-01	BREANNA STACK	2023-10-12
002	2021-01-01
002	2020-01-01	BREANNA L STACK	2021-07-14	BREANNA L STACK	2021-07-14
002	2019-01-01
002	2018-01-01	BREANNA STACK	2019-09-13
002	2017-01-01	NATASSJA GOETTSCH	2018-05-09
002	2016-01-01	PHILIP ANDERSEN	2017-07-27	PHILIP ANDERSEN	2017-07-27
002	2015-01-01	PHILIP ANDERSEN	2016-06-06
002	2014-01-01	NATASSJA ELLIOTT	2015-06-23
002	2013-01-01	PHILIP ANDERSEN	2014-05-16
002	2012-01-01	PHILIP ANDERSEN	2013-05-21
002	2011-01-01	PHILIP ANDERSEN	2012-06-27	PHILIP ANDERSEN	2012-06-27
002	2010-01-01	JEFF MAGNUSON	2011-06-01	JEFF MAGNUSON	2011-06-01

Plan Statistics for LAKEVIEW INDUSTRIES, INC 401(K) PLAN

401k plan membership statisitcs for LAKEVIEW INDUSTRIES, INC 401(K) PLAN

Measure Date Value
2023: LAKEVIEW INDUSTRIES, INC 401(K) PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 140
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 100
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 27
Total of all active and inactive participants 2023-01-01 127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 127
Number of participants with account balances 2023-01-01 99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 13
2022: LAKEVIEW INDUSTRIES, INC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 131
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 119
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 20
Total of all active and inactive participants 2022-01-01 139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 139
Number of participants with account balances 2022-01-01 106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0

Measure	Date	Value
2023: LAKEVIEW INDUSTRIES, INC 401(K) PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	140
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	100
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	27
Total of all active and inactive participants	2023-01-01	127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	127
Number of participants with account balances	2023-01-01	99
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	13
2022: LAKEVIEW INDUSTRIES, INC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	119
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	20
Total of all active and inactive participants	2022-01-01	139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	139
Number of participants with account balances	2022-01-01	106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0

Financial Data on LAKEVIEW INDUSTRIES, INC 401(K) PLAN

Measure	Date	Value
2023 : LAKEVIEW INDUSTRIES, INC 401(K) PLAN 2023 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2023-12-31	$0
Total unrealized appreciation/depreciation of assets	2023-12-31	$0
Total transfer of assets to this plan	2023-12-31	$0
Total transfer of assets from this plan	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	$1,308,105
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$288,119
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$281,807
Expenses. Certain deemed distributions of participant loans	2023-12-31	$0
Value of total corrective distributions	2023-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$587,052
Value of total assets at end of year	2023-12-31	$5,193,400
Value of total assets at beginning of year	2023-12-31	$4,173,414
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$6,312
Total interest from all sources	2023-12-31	$14,923
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$0
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	$0
Assets. Real estate other than employer real property at end of year	2023-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2023-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2023-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2023-12-31	$0
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$500,000
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	$466,627
Participant contributions at end of year	2023-12-31	$192,782
Participant contributions at beginning of year	2023-12-31	$123,221
Participant contributions at end of year	2023-12-31	$0
Participant contributions at beginning of year	2023-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2023-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2023-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$18,179
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2023-12-31	$0
Assets. Loans (other than to participants) at end of year	2023-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2023-12-31	$0
Other income not declared elsewhere	2023-12-31	$608
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
Income. Non cash contributions	2023-12-31	$0
Value of net income/loss	2023-12-31	$1,019,986
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$5,193,400
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$4,173,414
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
Assets. partnership/joint venture interests at end of year	2023-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2023-12-31	$0
Investment advisory and management fees	2023-12-31	$4,452
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-12-31	$0
Value of interest in pooled separate accounts at end of year	2023-12-31	$4,723,851
Value of interest in pooled separate accounts at beginning of year	2023-12-31	$3,707,795
Interest on participant loans	2023-12-31	$8,843
Income. Interest from loans (other than to participants)	2023-12-31	$0
Interest earned on other investments	2023-12-31	$6,080
Income. Interest from US Government securities	2023-12-31	$0
Income. Interest from corporate debt instruments	2023-12-31	$0
Value of interest in master investment trust accounts at end of year	2023-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2023-12-31	$0
Value of interest in common/collective trusts at end of year	2023-12-31	$0
Value of interest in common/collective trusts at beginning of year	2023-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2023-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2023-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2023-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2023-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2023-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2023-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2023-12-31	$276,767
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2023-12-31	$342,398
Expenses. Payments to insurance carriers foe the provision of benefits	2023-12-31	$0
Asset value of US Government securities at end of year	2023-12-31	$0
Asset value of US Government securities at beginning of year	2023-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-12-31	$0
Net investment gain/loss from pooled separate accounts	2023-12-31	$705,522
Net investment gain or loss from common/collective trusts	2023-12-31	$0
Net gain/loss from 103.12 investment entities	2023-12-31	$0
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	$102,246
Employer contributions (assets) at end of year	2023-12-31	$0
Employer contributions (assets) at beginning of year	2023-12-31	$0
Income. Dividends from preferred stock	2023-12-31	$0
Income. Dividends from common stock	2023-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$281,807
Asset. Corporate debt instrument preferred debt at end of year	2023-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2023-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2023-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2023-12-31	$0
Assets. Corporate common stocks other than exployer securities at end of year	2023-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2023-12-31	$0
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
Aggregate proceeds on sale of assets	2023-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2023-12-31	$0
Opinion of an independent qualified public accountant for this plan	2023-12-31	Unqualified
Accountancy firm name	2023-12-31	BGM CPA, LLC
Accountancy firm EIN	2023-12-31	200478282
2022 : LAKEVIEW INDUSTRIES, INC 401(K) PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2022-12-31	$0
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total transfer of assets to this plan	2022-12-31	$0
Total transfer of assets from this plan	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	$-133,314
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$113,676
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$108,178
Expenses. Certain deemed distributions of participant loans	2022-12-31	$0
Value of total corrective distributions	2022-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$563,892
Value of total assets at end of year	2022-12-31	$4,173,414
Value of total assets at beginning of year	2022-12-31	$4,420,404
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$5,498
Total interest from all sources	2022-12-31	$11,548
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
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	$0
Assets. Real estate other than employer real property at end of year	2022-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2022-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2022-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2022-12-31	$0
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$470,799
Participant contributions at end of year	2022-12-31	$123,221
Participant contributions at beginning of year	2022-12-31	$107,673
Participant contributions at end of year	2022-12-31	$0
Participant contributions at beginning of year	2022-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-12-31	$0
Assets. Loans (other than to participants) at end of year	2022-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2022-12-31	$0
Other income not declared elsewhere	2022-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Income. Non cash contributions	2022-12-31	$0
Value of net income/loss	2022-12-31	$-246,990
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,173,414
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$4,420,404
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
Assets. partnership/joint venture interests at end of year	2022-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2022-12-31	$0
Investment advisory and management fees	2022-12-31	$3,949
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$0
Value of interest in pooled separate accounts at end of year	2022-12-31	$3,707,795
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$3,910,262
Interest on participant loans	2022-12-31	$6,198
Income. Interest from loans (other than to participants)	2022-12-31	$0
Interest earned on other investments	2022-12-31	$5,350
Income. Interest from US Government securities	2022-12-31	$0
Income. Interest from corporate debt instruments	2022-12-31	$0
Value of interest in master investment trust accounts at end of year	2022-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2022-12-31	$0
Value of interest in common/collective trusts at end of year	2022-12-31	$0
Value of interest in common/collective trusts at beginning of year	2022-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$0
Assets. Value of investments in 103.12 investment entities at end of year	2022-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2022-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$342,398
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$402,469
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$0
Asset value of US Government securities at end of year	2022-12-31	$0
Asset value of US Government securities at beginning of year	2022-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$0
Net investment gain/loss from pooled separate accounts	2022-12-31	$-708,754
Net investment gain or loss from common/collective trusts	2022-12-31	$0
Net gain/loss from 103.12 investment entities	2022-12-31	$0
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	$93,093
Employer contributions (assets) at end of year	2022-12-31	$0
Employer contributions (assets) at beginning of year	2022-12-31	$0
Income. Dividends from preferred stock	2022-12-31	$0
Income. Dividends from common stock	2022-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$108,178
Asset. Corporate debt instrument preferred debt at end of year	2022-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2022-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2022-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2022-12-31	$0
Contract administrator fees	2022-12-31	$1,549
Assets. Corporate common stocks other than exployer securities at end of year	2022-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2022-12-31	$0
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
Aggregate proceeds on sale of assets	2022-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2022-12-31	$0
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	BOECKERMANN GRAFSTROM & MAYER LLC
Accountancy firm EIN	2022-12-31	200478282

Form 5500 Responses for LAKEVIEW INDUSTRIES, INC 401(K) PLAN

2023: LAKEVIEW INDUSTRIES, INC 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 – Insurance	Yes
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: LAKEVIEW INDUSTRIES, INC 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 – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

SENTRY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68810 )

Policy contract number

01-10902-01

Policy instance

Insurance contract or identification number	01-10902-01
Number of Individuals Covered	127
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $3,534
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

SENTRY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68810 )

Policy contract number

01-10902-01

Policy instance

Insurance contract or identification number	01-10902-01
Number of Individuals Covered	139
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,093
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
Commission paid to Insurance Broker	USD $3,093
Insurance broker organization code?	3

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Company Name:	LAKEVIEW INDUSTRIES, INC
Employer identification number (EIN):	411427378
NAIC Classification:	326200