401k Plan data: LAKEWOOD RESOURCE AND REFERRAL CENTER WRAP PLAN plan

LAKEWOOD RESOURCE AND REFERRAL CENTER WRAP PLAN 401k Plan overview

Plan Name	LAKEWOOD RESOURCE AND REFERRAL CENTER WRAP PLAN
Plan identification number	501

LAKEWOOD RESOURCE AND REFERRAL CENTER WRAP PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Other welfare benefit cover

401k Sponsoring company profile

LAKEWOOD RESOURCE AND REFERRAL has sponsored the creation of one or more 401k plans.

Company Name: LAKEWOOD RESOURCE AND REFERRAL

Employer identification number (EIN): 201324142

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKEWOOD RESOURCE AND REFERRAL CENTER WRAP PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 TEHILA NEY 2023-10-11

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	TEHILA NEY	2023-10-11

Plan Statistics for LAKEWOOD RESOURCE AND REFERRAL CENTER WRAP PLAN

401k plan membership statisitcs for LAKEWOOD RESOURCE AND REFERRAL CENTER WRAP PLAN

Measure Date Value
2022: LAKEWOOD RESOURCE AND REFERRAL CENTER WRAP PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 93
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 95
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 0
Total of all active and inactive participants 2022-01-01 95

Measure	Date	Value
2022: LAKEWOOD RESOURCE AND REFERRAL CENTER WRAP PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	93
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	95
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	0
Total of all active and inactive participants	2022-01-01	95

Form 5500 Responses for LAKEWOOD RESOURCE AND REFERRAL CENTER WRAP PLAN

2022: LAKEWOOD RESOURCE AND REFERRAL CENTER WRAP PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
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

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5393650

Policy instance

Insurance contract or identification number	5393650
Number of Individuals Covered	312
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $13,555
Total amount of fees paid to insurance company	USD $56
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $107,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,037
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E3885985

Policy instance

Insurance contract or identification number	E3885985
Number of Individuals Covered	33
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,614
Total amount of fees paid to insurance company	USD $409
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,314
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

MONY (National Association of Insurance Commissioners NAIC id number: 78077 )

Policy contract number

006695

Policy instance

Insurance contract or identification number	006695
Number of Individuals Covered	209
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,371
Total amount of fees paid to insurance company	USD $419
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $8,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,371
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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Company Name:	LAKEWOOD RESOURCE AND REFERRAL
Employer identification number (EIN):	201324142
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)