401k Plan data: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN plan

LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 401k Plan overview

Plan Name	LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN
Plan identification number	001

LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

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

Company Name: LAKEVIEW PHARMACY, INC

Employer identification number (EIN): 391583109

NAIC Classification: 446110
NAIC Description: Pharmacies and Drug Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01 PETER CIARAMITA 2021-08-02
001 2020-01-01 PETE CIARAMITA 2022-09-27
001 2019-01-01
001 2018-01-01 PETER CIARAMITA
001 2017-01-01 PETER CIARAMITA
001 2017-01-01 PETER CIARAMITA
001 2016-01-01 PETER CIARAMITA
001 2015-01-01 PETER CIARAMITA
001 2014-01-01 PETER CIARAMITA 2015-04-14
001 2013-01-01 PETER CIARAMITA 2014-06-11
001 2012-01-01 PETER CIARAMITA 2013-09-13
001 2011-01-01 PETER CIARAMITA 2012-05-25 PETER CIARAMITA 2012-05-25
001 2010-01-01 PETE CIARAMITA 2011-05-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2020-01-01	PETER CIARAMITA	2021-08-02
001	2020-01-01	PETE CIARAMITA	2022-09-27
001	2019-01-01
001	2018-01-01	PETER CIARAMITA
001	2017-01-01	PETER CIARAMITA
001	2017-01-01	PETER CIARAMITA
001	2016-01-01	PETER CIARAMITA
001	2015-01-01	PETER CIARAMITA
001	2014-01-01	PETER CIARAMITA	2015-04-14
001	2013-01-01	PETER CIARAMITA	2014-06-11
001	2012-01-01	PETER CIARAMITA	2013-09-13
001	2011-01-01	PETER CIARAMITA	2012-05-25	PETER CIARAMITA	2012-05-25
001	2010-01-01	PETE CIARAMITA	2011-05-23

Plan Statistics for LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN

401k plan membership statisitcs for LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN

Measure Date Value
2019: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 16
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 5
Total of all active and inactive participants 2019-01-01 21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 21
Number of participants with account balances 2019-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 13
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 4
Total of all active and inactive participants 2018-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 17
Number of participants with account balances 2018-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 10
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 7
Total of all active and inactive participants 2017-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 17
Number of participants with account balances 2017-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 2
2016: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 16
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 4
Total of all active and inactive participants 2016-01-01 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 20
Number of participants with account balances 2016-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 2
2015: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 17
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 5
Total of all active and inactive participants 2015-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 22
Number of participants with account balances 2015-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 3

Measure	Date	Value
2019: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	16
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	5
Total of all active and inactive participants	2019-01-01	21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	21
Number of participants with account balances	2019-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	13
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	4
Total of all active and inactive participants	2018-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	17
Number of participants with account balances	2018-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	10
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	7
Total of all active and inactive participants	2017-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	17
Number of participants with account balances	2017-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	2
2016: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	16
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	4
Total of all active and inactive participants	2016-01-01	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	20
Number of participants with account balances	2016-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2
2015: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	17
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	5
Total of all active and inactive participants	2015-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	22
Number of participants with account balances	2015-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	3

Financial Data on LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN

Measure	Date	Value
2019 : LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$387,319
Expenses. Total of all expenses incurred	2019-12-31	$47,891
Benefits paid (including direct rollovers)	2019-12-31	$47,351
Total plan assets at end of year	2019-12-31	$1,706,096
Total plan assets at beginning of year	2019-12-31	$1,366,668
Value of fidelity bond covering the plan	2019-12-31	$200,000
Total contributions received or receivable from participants	2019-12-31	$89,994
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$266,604
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$339,428
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$1,706,096
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$1,366,668
Total contributions received or receivable from employer(s)	2019-12-31	$30,721
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$540
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$-12,587
Expenses. Total of all expenses incurred	2018-12-31	$240,771
Benefits paid (including direct rollovers)	2018-12-31	$240,001
Total plan assets at end of year	2018-12-31	$1,366,668
Total plan assets at beginning of year	2018-12-31	$1,620,026
Value of fidelity bond covering the plan	2018-12-31	$200,000
Total contributions received or receivable from participants	2018-12-31	$45,453
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Other income received	2018-12-31	$-84,107
Net income (gross income less expenses)	2018-12-31	$-253,358
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$1,366,668
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$1,620,026
Total contributions received or receivable from employer(s)	2018-12-31	$26,067
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$770
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$285,524
Expenses. Total of all expenses incurred	2017-12-31	$10,215
Benefits paid (including direct rollovers)	2017-12-31	$9,555
Total plan assets at end of year	2017-12-31	$1,618,198
Total plan assets at beginning of year	2017-12-31	$1,342,889
Value of fidelity bond covering the plan	2017-12-31	$200,000
Total contributions received or receivable from participants	2017-12-31	$34,105
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$229,961
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$275,309
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$1,618,198
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$1,342,889
Total contributions received or receivable from employer(s)	2017-12-31	$21,458
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$660
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$145,161
Expenses. Total of all expenses incurred	2016-12-31	$36,628
Benefits paid (including direct rollovers)	2016-12-31	$36,188
Total plan assets at end of year	2016-12-31	$1,342,889
Total plan assets at beginning of year	2016-12-31	$1,234,356
Value of fidelity bond covering the plan	2016-12-31	$150,000
Total contributions received or receivable from participants	2016-12-31	$45,679
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$87,015
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$108,533
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,342,889
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,234,356
Total contributions received or receivable from employer(s)	2016-12-31	$12,467
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$440
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$-823
Expenses. Total of all expenses incurred	2015-12-31	$4,247
Benefits paid (including direct rollovers)	2015-12-31	$1,038
Total plan assets at end of year	2015-12-31	$1,234,356
Total plan assets at beginning of year	2015-12-31	$1,239,426
Value of fidelity bond covering the plan	2015-12-31	$150,000
Total contributions received or receivable from participants	2015-12-31	$35,958
Contributions received from other sources (not participants or employers)	2015-12-31	$830
Other income received	2015-12-31	$-63,771
Net income (gross income less expenses)	2015-12-31	$-5,070
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,234,356
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,239,426
Total contributions received or receivable from employer(s)	2015-12-31	$26,160
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$3,209
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0

Form 5500 Responses for LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN

2019: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

813191

Policy instance

Insurance contract or identification number	813191
Number of Individuals Covered	21
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $750
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?	Yes
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 $0
Amount paid for insurance broker fees	750
Additional information about fees paid to insurance broker	TPA FEE'S
Insurance broker organization code?	5

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

813191

Policy instance

Insurance contract or identification number	813191
Number of Individuals Covered	17
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $759
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?	Yes
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 $0
Amount paid for insurance broker fees	759
Additional information about fees paid to insurance broker	TPA FEE'S
Insurance broker organization code?	5

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

813191

Policy instance

Insurance contract or identification number	813191
Number of Individuals Covered	17
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $716
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?	Yes
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 $0
Amount paid for insurance broker fees	716
Additional information about fees paid to insurance broker	TPA FEE'S
Insurance broker organization code?	5
Insurance broker name	PPG RETIREMENT PLAN SERVICES

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

813191

Policy instance

Insurance contract or identification number	813191
Number of Individuals Covered	21
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,888
Are there contracts with allocated funds for individual policies?	No
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?	Yes
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
Amount paid for insurance broker fees	4888
Additional information about fees paid to insurance broker	TPA FEE
Insurance broker organization code?	5
Insurance broker name	PPG RETIREMENT PLAN SERVICES

Potentially related plans

LAKEVIEW PHARMACY, INC PROFIT SHARING PLAN [EIN = 871958910]

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Company Name:	LAKEVIEW PHARMACY, INC
Employer identification number (EIN):	391583109
NAIC Classification:	446110
NAIC Description:	Pharmacies and Drug Stores