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CAPITOL LAKES VISION PLAN 401k Plan overview

Plan NameCAPITOL LAKES VISION PLAN
Plan identification number 504

CAPITOL LAKES VISION PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Vision

401k Sponsoring company profile

CAPITOL LAKES has sponsored the creation of one or more 401k plans.

Company Name:CAPITOL LAKES
Employer identification number (EIN):391412320
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAPITOL LAKES VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042019-01-01LYNDELL SMITH2020-06-30
5042019-01-01EMILY PERRY2021-07-14
5042018-01-01
5042017-01-01
5042016-01-01LYNDELL SMITH2019-02-21

Plan Statistics for CAPITOL LAKES VISION PLAN

401k plan membership statisitcs for CAPITOL LAKES VISION PLAN

Measure Date Value
2019: CAPITOL LAKES VISION PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01111
Total number of active participants reported on line 7a of the Form 55002019-01-01114
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01114
Number of employers contributing to the scheme2019-01-010
2018: CAPITOL LAKES VISION PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01111
Total number of active participants reported on line 7a of the Form 55002018-01-01111
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01111
Number of employers contributing to the scheme2018-01-010
2017: CAPITOL LAKES VISION PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01110
Total number of active participants reported on line 7a of the Form 55002017-01-01111
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01111
2016: CAPITOL LAKES VISION PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01102
Total number of active participants reported on line 7a of the Form 55002016-01-01110
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01110

Form 5500 Responses for CAPITOL LAKES VISION PLAN

2019: CAPITOL LAKES VISION PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedYes
2019-01-01This submission is the final filingYes
2019-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: CAPITOL LAKES VISION PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: CAPITOL LAKES VISION PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: CAPITOL LAKES VISION PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30044020
Policy instance 1
Insurance contract or identification number30044020
Number of Individuals Covered114
Insurance policy start date2019-01-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30044020
Policy instance 1
Insurance contract or identification number30044020
Number of Individuals Covered111
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30044020
Policy instance 1
Insurance contract or identification number30044020
Number of Individuals Covered111
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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