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LAKE STATES LUMBER INC DENTAL PLAN 401k Plan overview

Plan NameLAKE STATES LUMBER INC DENTAL PLAN
Plan identification number 504

LAKE STATES LUMBER INC DENTAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Dental

401k Sponsoring company profile

LAKE STATES LUMBER INC has sponsored the creation of one or more 401k plans.

Company Name:LAKE STATES LUMBER INC
Employer identification number (EIN):411357567
NAIC Classification:423300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKE STATES LUMBER INC DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042018-01-01LINDSAY WILDT2019-10-08
5042017-01-01LINDSAY WILDT2019-10-08
5042016-01-01LINDSAY WILDT2019-10-08
5042015-01-01ANDREW KICK ANDREW KICK2016-07-29
5042014-01-01ANDREW KICK ANDREW KICK2015-07-27
5042013-01-01ANDREW KICK
5042012-01-01ANDREW KICK ANDREW KICK2013-07-10
5042011-01-01ANDREW KICK

Plan Statistics for LAKE STATES LUMBER INC DENTAL PLAN

401k plan membership statisitcs for LAKE STATES LUMBER INC DENTAL PLAN

Measure Date Value
2018: LAKE STATES LUMBER INC DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01139
Total number of active participants reported on line 7a of the Form 55002018-01-010
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 participants2018-01-010
Number of employers contributing to the scheme2018-01-010
2017: LAKE STATES LUMBER INC DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01138
Total number of active participants reported on line 7a of the Form 55002017-01-01139
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 participants2017-01-01139
Number of employers contributing to the scheme2017-01-010
2016: LAKE STATES LUMBER INC DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01138
Total number of active participants reported on line 7a of the Form 55002016-01-01145
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 participants2016-01-01145
Number of employers contributing to the scheme2016-01-010
2015: LAKE STATES LUMBER INC DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01121
Total number of active participants reported on line 7a of the Form 55002015-01-01138
Total of all active and inactive participants2015-01-01138
Total participants2015-01-01138
2014: LAKE STATES LUMBER INC DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01119
Total number of active participants reported on line 7a of the Form 55002014-01-01121
Total of all active and inactive participants2014-01-01121
Total participants2014-01-01121
2013: LAKE STATES LUMBER INC DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01119
Total number of active participants reported on line 7a of the Form 55002013-01-01119
Total of all active and inactive participants2013-01-01119
Total participants2013-01-01119
2012: LAKE STATES LUMBER INC DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01119
Total number of active participants reported on line 7a of the Form 55002012-01-01117
Number of retired or separated participants receiving benefits2012-01-012
Total of all active and inactive participants2012-01-01119
Total participants2012-01-01119
2011: LAKE STATES LUMBER INC DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01106
Total number of active participants reported on line 7a of the Form 55002011-01-01117
Number of retired or separated participants receiving benefits2011-01-011
Total of all active and inactive participants2011-01-01118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-011
Total participants2011-01-01119

Form 5500 Responses for LAKE STATES LUMBER INC DENTAL PLAN

2018: LAKE STATES LUMBER INC DENTAL PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01This submission is the final filingYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: LAKE STATES LUMBER INC DENTAL 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: LAKE STATES LUMBER INC DENTAL PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: LAKE STATES LUMBER INC DENTAL PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: LAKE STATES LUMBER INC DENTAL PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: LAKE STATES LUMBER INC DENTAL PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: LAKE STATES LUMBER INC DENTAL PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: LAKE STATES LUMBER INC DENTAL PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number0051600000
Policy instance 1
Insurance contract or identification number0051600000
Number of Individuals Covered132
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,037
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,037
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )
Policy contract number0051600000
Policy instance 1
Insurance contract or identification number0051600000
Number of Individuals Covered139
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $6,460
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number24178
Policy instance 1
Insurance contract or identification number24178
Number of Individuals Covered243
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $7,577
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $80,933
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,577
Insurance broker organization code?3
Insurance broker nameTIC DBA THE INSURANCE CENTER
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number24178
Policy instance 1
Insurance contract or identification number24178
Number of Individuals Covered228
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $6,736
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $63,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,736
Insurance broker organization code?3
Insurance broker nameTIC DBA THE INSURANCE CENTER
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number24178
Policy instance 1
Insurance contract or identification number24178
Number of Individuals Covered216
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,016
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $75,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,016
Insurance broker organization code?3
Insurance broker nameTIC DBA THE INSURANCE CENTER
HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )
Policy contract number24178
Policy instance 1
Insurance contract or identification number24178
Number of Individuals Covered220
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,579
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,579
Insurance broker organization code?3
Insurance broker nameTIC DBA THE INSURANCE CENTER
HEALTHPARTNERS (National Association of Insurance Commissioners NAIC id number: 95766 )
Policy contract number24178
Policy instance 1
Insurance contract or identification number24178
Number of Individuals Covered234
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,730
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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