401k Plan data: LGE DESIGN BUILD HEALTH AND WELFARE PLAN plan

LGE DESIGN BUILD HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	LGE DESIGN BUILD HEALTH AND WELFARE PLAN
Plan identification number	501

LGE DESIGN BUILD HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

LGE DESIGN BUILD has sponsored the creation of one or more 401k plans.

Company Name: LGE DESIGN BUILD

Employer identification number (EIN): 464252835

NAIC Classification: 236200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LGE DESIGN BUILD HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-02-01 AMY FRICKE 2024-01-08

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-02-01	AMY FRICKE	2024-01-08

Plan Statistics for LGE DESIGN BUILD HEALTH AND WELFARE PLAN

401k plan membership statisitcs for LGE DESIGN BUILD HEALTH AND WELFARE PLAN

Measure Date Value
2023: LGE DESIGN BUILD HEALTH AND WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year 2023-02-01 100
Total number of active participants reported on line 7a of the Form 5500 2023-02-01 109
Number of retired or separated participants receiving benefits 2023-02-01 0
Number of other retired or separated participants entitled to future benefits 2023-02-01 0
Total of all active and inactive participants 2023-02-01 109
Number of employers contributing to the scheme 2023-02-01 0

Measure	Date	Value
2023: LGE DESIGN BUILD HEALTH AND WELFARE PLAN 2023 401k membership
Total participants, beginning-of-year	2023-02-01	100
Total number of active participants reported on line 7a of the Form 5500	2023-02-01	109
Number of retired or separated participants receiving benefits	2023-02-01	0
Number of other retired or separated participants entitled to future benefits	2023-02-01	0
Total of all active and inactive participants	2023-02-01	109
Number of employers contributing to the scheme	2023-02-01	0

Form 5500 Responses for LGE DESIGN BUILD HEALTH AND WELFARE PLAN

2023: LGE DESIGN BUILD HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-02-01	Type of plan entity	Single employer plan
2023-02-01	First time form 5500 has been submitted	Yes
2023-02-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2023-02-01	Plan funding arrangement – Insurance	Yes
2023-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )

Policy contract number

37277

Policy instance

Insurance contract or identification number	37277
Number of Individuals Covered	198
Insurance policy start date	2023-02-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $19,969
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $397,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,969
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53597 )

Policy contract number

37069

Policy instance

Insurance contract or identification number	37069
Number of Individuals Covered	185
Insurance policy start date	2023-02-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $2,712
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $26,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,712
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0BHQV

Policy instance

Insurance contract or identification number	GLUG0BHQV
Number of Individuals Covered	109
Insurance policy start date	2023-02-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $9,062
Total amount of fees paid to insurance company	USD $3,579
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $45,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,062
Amount paid for insurance broker fees	3579
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3

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Company Name:	LGE DESIGN BUILD
Employer identification number (EIN):	464252835
NAIC Classification:	236200