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| Plan Name | LAKE SHORE INN 401K PLAN |
| Plan identification number | 001 |
| 401k Plan Type | Defined Contribution Pension |
| Plan Features/Benefits |
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| Company Name: | LAKE SHORE INN |
| Employer identification number (EIN): | 410841332 |
| NAIC Classification: | 623000 |
| NAIC Description: | Nursing and Residential Care Facilities |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 001 | 2021-01-01 | PETER MADEL III | 2022-06-15 | ||
| 001 | 2020-01-01 | PETER MADEL III | 2021-05-06 | ||
| 001 | 2019-01-01 | PETER MADEL III | 2020-05-11 | ||
| 001 | 2018-01-01 | PETER MADEL III | 2019-06-18 | ||
| 001 | 2017-01-01 | PETER MADEL III | 2018-07-12 | ||
| 001 | 2016-01-01 | PETER MADEL III | 2017-07-05 | ||
| 001 | 2015-01-01 | PETER MADEL III | 2016-07-14 | ||
| 001 | 2014-01-01 | PETER MADEL III | 2015-06-25 | ||
| 001 | 2013-01-01 | PETER MADEL III | 2014-07-29 | ||
| 001 | 2012-01-01 | PETER MADEL III | 2013-07-01 | ||
| 001 | 2011-01-01 | PETER MADEL III | 2012-04-17 | ||
| 001 | 2010-01-01 | PETER MADEL III | 2011-05-24 | ||
| 001 | 2009-01-01 | PETER MADEL III |
| Measure | Date | Value |
|---|---|---|
| 2022 : LAKE SHORE INN 401K PLAN 2022 401k financial data | ||
| Total expenses incurred by plan in this plan year | 2022-06-15 | 19674 |
| Net assets as of the end of the plan year | 2022-06-15 | 1315577 |
| Total assets as of the beginning of the plan year | 2022-06-15 | 1145071 |
| Value of plan covered by a fidelity bond | 2022-06-15 | 100000 |
| Participant contributions to plan in this plan year | 2022-06-15 | 32153 |
| Other income to plan in this plan year | 2022-06-15 | 158027 |
| Plan net income in this plan year | 2022-06-15 | 170506 |
| Net assets as of the end of the plan year | 2022-06-15 | 1315577 |
| Net assets as of the beginning of the plan year | 2022-06-15 | 1145071 |
| Fees paid to broker by Benefit Provider | 2022-06-15 | 686 |
| Expensese paid to adminstrative service provicers from plan in this plan year | 2022-06-15 | 18485 |
| 2009 : LAKE SHORE INN 401K PLAN 2009 401k financial data | ||
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2009-12-31 | $0 |
| 2009: LAKE SHORE INN 401K PLAN 2009 form 5500 responses | ||
|---|---|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
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