401k Plan data: LAKE AIR METAL PRODUCTS LLC HEALTH plan

LAKE AIR METAL PRODUCTS LLC HEALTH 401k Plan overview

Plan Name	LAKE AIR METAL PRODUCTS LLC HEALTH
Plan identification number	502

LAKE AIR METAL PRODUCTS LLC HEALTH Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

LAKE AIR METAL PRODUCTS LLC has sponsored the creation of one or more 401k plans.

Company Name: LAKE AIR METAL PRODUCTS LLC

Employer identification number (EIN): 411939951

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKE AIR METAL PRODUCTS LLC HEALTH

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2016-01-01 SANDRA BAKER
502 2015-01-01 SANDRA BAKER
502 2015-01-01 SANDRA BAKER
502 2014-01-01 SANDI KAROLERSKI
502 2013-01-01 SANDI KAROLEWSKI

Plan id#	Filing Submission Date	Name of Administrator
502	2016-01-01	SANDRA BAKER
502	2015-01-01	SANDRA BAKER
502	2015-01-01	SANDRA BAKER
502	2014-01-01	SANDI KAROLERSKI
502	2013-01-01	SANDI KAROLEWSKI

Plan Statistics for LAKE AIR METAL PRODUCTS LLC HEALTH

401k plan membership statisitcs for LAKE AIR METAL PRODUCTS LLC HEALTH

Measure Date Value
2016: LAKE AIR METAL PRODUCTS LLC HEALTH 2016 401k membership
Total participants, beginning-of-year 2016-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 111
Number of retired or separated participants receiving benefits 2016-01-01 4
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 115
2015: LAKE AIR METAL PRODUCTS LLC HEALTH 2015 401k membership
Total participants, beginning-of-year 2015-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 118
Number of retired or separated participants receiving benefits 2015-01-01 4
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 122
2014: LAKE AIR METAL PRODUCTS LLC HEALTH 2014 401k membership
Total participants, beginning-of-year 2014-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 129
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 129
2013: LAKE AIR METAL PRODUCTS LLC HEALTH 2013 401k membership
Total participants, beginning-of-year 2013-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 124
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 124
Number of participants with account balances 2013-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0

Measure	Date	Value
2016: LAKE AIR METAL PRODUCTS LLC HEALTH 2016 401k membership
Total participants, beginning-of-year	2016-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	111
Number of retired or separated participants receiving benefits	2016-01-01	4
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	115
2015: LAKE AIR METAL PRODUCTS LLC HEALTH 2015 401k membership
Total participants, beginning-of-year	2015-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	118
Number of retired or separated participants receiving benefits	2015-01-01	4
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	122
2014: LAKE AIR METAL PRODUCTS LLC HEALTH 2014 401k membership
Total participants, beginning-of-year	2014-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	129
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	129
2013: LAKE AIR METAL PRODUCTS LLC HEALTH 2013 401k membership
Total participants, beginning-of-year	2013-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	124
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	124
Number of participants with account balances	2013-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0

Form 5500 Responses for LAKE AIR METAL PRODUCTS LLC HEALTH

2016: LAKE AIR METAL PRODUCTS LLC HEALTH 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 – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: LAKE AIR METAL PRODUCTS LLC HEALTH 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	Yes
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 – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: LAKE AIR METAL PRODUCTS LLC HEALTH 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: LAKE AIR METAL PRODUCTS LLC HEALTH 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )

Policy contract number

20169

Policy instance

Insurance contract or identification number	20169
Number of Individuals Covered	207
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $19,152
Total amount of fees paid to insurance company	USD $6,379
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $640,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,152
Amount paid for insurance broker fees	6379
Additional information about fees paid to insurance broker	PRODUCTION BONUS
Insurance broker organization code?	3
Insurance broker name	CORPORATE HEALTH SYSTEMS INC

MEDICA (National Association of Insurance Commissioners NAIC id number: 1259 )

Policy contract number

146023

Policy instance

Insurance contract or identification number	146023
Number of Individuals Covered	205
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $15,775
Total amount of fees paid to insurance company	USD $2,074
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?	No
Health Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $708,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,775
Amount paid for insurance broker fees	2074
Additional information about fees paid to insurance broker	BROKER INCENTIVE
Insurance broker organization code?	3
Insurance broker name	CORPORATE HEALTH SYSTEMS INC

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Company Name:	LAKE AIR METAL PRODUCTS LLC
Employer identification number (EIN):	411939951
NAIC Classification:	332900