401k Plan data: LUMBERMENS BRICK & SUPPLY DBA FIREPLACE STONE AND PATIO BENEFIT PLAN plan

LUMBERMENS BRICK & SUPPLY DBA FIREPLACE STONE AND PATIO BENEFIT PLAN 401k Plan overview

Plan Name	LUMBERMENS BRICK & SUPPLY DBA FIREPLACE STONE AND PATIO BENEFIT PLAN
Plan identification number	502

LUMBERMENS BRICK & SUPPLY DBA FIREPLACE STONE AND PATIO BENEFIT PLAN Benefits

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

401k Sponsoring company profile

LUMBERMENS BRICK & SUPPLY CO. has sponsored the creation of one or more 401k plans.

Company Name: LUMBERMENS BRICK & SUPPLY CO.

Employer identification number (EIN): 470226995

NAIC Classification: 423300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LUMBERMENS BRICK & SUPPLY DBA FIREPLACE STONE AND PATIO BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-01-01 JEFF FUNK 2024-09-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2023-01-01	JEFF FUNK	2024-09-23

Form 5500 Responses for LUMBERMENS BRICK & SUPPLY DBA FIREPLACE STONE AND PATIO BENEFIT PLAN

2023: LUMBERMENS BRICK & SUPPLY DBA FIREPLACE STONE AND PATIO BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 )

Policy contract number

A00013

Policy instance

Insurance contract or identification number	A00013
Number of Individuals Covered	58
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $22,960
Total amount of fees paid to insurance company	USD $9,936
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $697,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

1120561

Policy instance

Insurance contract or identification number	1120561
Number of Individuals Covered	151
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $8,265
Total amount of fees paid to insurance company	USD $1,656
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $62,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	LUMBERMENS BRICK & SUPPLY CO.
Employer identification number (EIN):	470226995
NAIC Classification:	423300