401k Plan data: F.S. LOPKE CONTRACTING, INC. EMPLOYEE BENEFITS PLAN plan

F.S. LOPKE CONTRACTING, INC. EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	F.S. LOPKE CONTRACTING, INC. EMPLOYEE BENEFITS PLAN
Plan identification number	505

F.S. LOPKE CONTRACTING, INC. EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

F.S. LOPKE CONTRACTING, INC. has sponsored the creation of one or more 401k plans.

Company Name: F.S. LOPKE CONTRACTING, INC.

Employer identification number (EIN): 161012179

NAIC Classification: 212320
NAIC Description: Sand, Gravel, Clay, and Ceramic and Refractory Minerals Mining and Quarrying

Form 5500 Filing Information

Submission information for form 5500 for 401k plan F.S. LOPKE CONTRACTING, INC. EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2013-06-01 STEVE GREGG

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2013-06-01	STEVE GREGG

Plan Statistics for F.S. LOPKE CONTRACTING, INC. EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for F.S. LOPKE CONTRACTING, INC. EMPLOYEE BENEFITS PLAN

Measure Date Value
2013: F.S. LOPKE CONTRACTING, INC. EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 108
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 0
Number of retired or separated participants receiving benefits 2013-06-01 0
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 0

Measure	Date	Value
2013: F.S. LOPKE CONTRACTING, INC. EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	108
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	0
Number of retired or separated participants receiving benefits	2013-06-01	0
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	0

Form 5500 Responses for F.S. LOPKE CONTRACTING, INC. EMPLOYEE BENEFITS PLAN

2013: F.S. LOPKE CONTRACTING, INC. EMPLOYEE BENEFITS PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	First time form 5500 has been submitted	Yes
2013-06-01	Submission has been amended	Yes
2013-06-01	This submission is the final filing	Yes
2013-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-06-01	Plan is a collectively bargained plan	No
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00210902

Policy instance

Insurance contract or identification number	00210902
Number of Individuals Covered	107
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $2,167
Total amount of fees paid to insurance company	USD $959
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
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $14,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,823
Amount paid for insurance broker fees	959
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	THE PARTNERS ELLIS EDSON BEAUD & CH

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )

Policy contract number

00005672

Policy instance

Insurance contract or identification number	00005672
Number of Individuals Covered	92
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31
Total amount of commissions paid to insurance broker	USD $55,212
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $1,471,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $46,507
Insurance broker organization code?	3
Insurance broker name	THE PARTNERS ELLIS EDSON-BEAUDRY

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Company Name:	F.S. LOPKE CONTRACTING, INC.
Employer identification number (EIN):	161012179
NAIC Classification:	212320
NAIC Description:	Sand, Gravel, Clay, and Ceramic and Refractory Minerals Mining and Quarrying