401k Plan data: NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN plan

NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN
Plan identification number	002

NORTHERN LAKES CONCRETE, INC. 401(K) 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

NORTHERN LAKES CONCRETE, INC. has sponsored the creation of one or more 401k plans.

Company Name: NORTHERN LAKES CONCRETE, INC.

Employer identification number (EIN): 391929186

NAIC Classification: 236200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2014-02-01 BRIAN PITLIK 2014-11-13 BRIAN PITLIK 2014-11-13
002 2013-02-01 BRIAN PITLIK 2014-11-03 BRIAN PITLIK 2014-11-03
002 2012-02-01 JILL WALKOWSKI 2013-10-14 JILL WALKOWSKI 2013-10-14
002 2011-02-01 JILL WALKOWSKI 2012-11-07 JILL WALKOWSKI 2012-11-07
002 2010-02-01 JILL WALKOWSKI 2012-01-12 JILL WALKOWSKI 2012-01-12
002 2008-10-15 JILL WALKOWSKI

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2014-02-01	BRIAN PITLIK	2014-11-13	BRIAN PITLIK	2014-11-13
002	2013-02-01	BRIAN PITLIK	2014-11-03	BRIAN PITLIK	2014-11-03
002	2012-02-01	JILL WALKOWSKI	2013-10-14	JILL WALKOWSKI	2013-10-14
002	2011-02-01	JILL WALKOWSKI	2012-11-07	JILL WALKOWSKI	2012-11-07
002	2010-02-01	JILL WALKOWSKI	2012-01-12	JILL WALKOWSKI	2012-01-12
002	2008-10-15	JILL WALKOWSKI

Plan Statistics for NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2008: NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN 2008 401k membership
Total participants, beginning-of-year 2008-10-15 43
Total number of active participants reported on line 7a of the Form 5500 2008-10-15 44
Total of all active and inactive participants 2008-10-15 44
Total participants 2008-10-15 44
Number of participants with account balances 2008-10-15 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2008-10-15 1

Measure	Date	Value
2008: NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN 2008 401k membership
Total participants, beginning-of-year	2008-10-15	43
Total number of active participants reported on line 7a of the Form 5500	2008-10-15	44
Total of all active and inactive participants	2008-10-15	44
Total participants	2008-10-15	44
Number of participants with account balances	2008-10-15	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2008-10-15	1

Financial Data on NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2009 : NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN 2009 401k financial data
Transfers to/from the plan	2009-01-31	$581,739
Total income from all sources	2009-01-31	$-18,091
Expenses. Total of all expenses incurred	2009-01-31	$725
Benefits paid (including direct rollovers)	2009-01-31	$489
Total plan assets at end of year	2009-01-31	$562,923
Total plan assets at beginning of year	2009-01-31	$0
Value of fidelity bond covering the plan	2009-01-31	$500,000
Total contributions received or receivable from participants	2009-01-31	$10,600
Expenses. Other expenses not covered elsewhere	2009-01-31	$236
Other income received	2009-01-31	$-28,691
Net income (gross income less expenses)	2009-01-31	$-18,816
Net plan assets at end of year (total assets less liabilities)	2009-01-31	$562,923
Net plan assets at beginning of year (total assets less liabilities)	2009-01-31	$0

Form 5500 Responses for NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN

2008: NORTHERN LAKES CONCRETE, INC. 401(K) PROFIT SHARING PLAN 2008 form 5500 responses
2008-10-15	Type of plan entity	Single employer plan
2008-10-15	First time form 5500 has been submitted	Yes
2008-10-15	Submission has been amended	Yes
2008-10-15	This submission is the final filing	No
2008-10-15	This return/report is a short plan year return/report (less than 12 months)	Yes
2008-10-15	Plan is a collectively bargained plan	No
2008-10-15	Plan funding arrangement – Insurance	Yes
2008-10-15	Plan funding arrangement – Trust	Yes
2008-10-15	Plan benefit arrangement – Insurance	Yes
2008-10-15	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

5-20866

Policy instance

Insurance contract or identification number	5-20866
Number of Individuals Covered	44
Insurance policy start date	2008-10-15
Insurance policy end date	2009-01-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NORTHERN LAKES CONCRETE, INC.
Employer identification number (EIN):	391929186
NAIC Classification:	236200