401k Plan data: KLUMB LUMBER & FOREST PRODUCTS, INC. WELFARE BENEFIT PLAN plan

KLUMB LUMBER & FOREST PRODUCTS, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	KLUMB LUMBER & FOREST PRODUCTS, INC. WELFARE BENEFIT PLAN
Plan identification number	501

KLUMB LUMBER & FOREST PRODUCTS, INC. WELFARE BENEFIT 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) Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

KLUMB LUMBER & FOREST PRODUCTS, INC. has sponsored the creation of one or more 401k plans.

Company Name: KLUMB LUMBER & FOREST PRODUCTS, INC.

Employer identification number (EIN): 824103817

NAIC Classification: 423300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KLUMB LUMBER & FOREST PRODUCTS, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-06-01 KAREN MCQUINN 2020-02-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-06-01	KAREN MCQUINN	2020-02-15

Plan Statistics for KLUMB LUMBER & FOREST PRODUCTS, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for KLUMB LUMBER & FOREST PRODUCTS, INC. WELFARE BENEFIT PLAN

Measure Date Value
2018: KLUMB LUMBER & FOREST PRODUCTS, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-06-01 193
Total number of active participants reported on line 7a of the Form 5500 2018-06-01 193
Total of all active and inactive participants 2018-06-01 193

Measure	Date	Value
2018: KLUMB LUMBER & FOREST PRODUCTS, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-06-01	193
Total number of active participants reported on line 7a of the Form 5500	2018-06-01	193
Total of all active and inactive participants	2018-06-01	193

Form 5500 Responses for KLUMB LUMBER & FOREST PRODUCTS, INC. WELFARE BENEFIT PLAN

2018: KLUMB LUMBER & FOREST PRODUCTS, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	First time form 5500 has been submitted	Yes
2018-06-01	Plan funding arrangement – Insurance	Yes
2018-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

914633

Policy instance

Insurance contract or identification number	914633
Number of Individuals Covered	193
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $52,400
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $996,191
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	52400
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00487387

Policy instance

Insurance contract or identification number	00487387
Number of Individuals Covered	128
Insurance policy start date	2018-06-01
Insurance policy end date	2019-05-31
Total amount of commissions paid to insurance broker	USD $16,956
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $139,513
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,956

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Company Name:	KLUMB LUMBER & FOREST PRODUCTS, INC.
Employer identification number (EIN):	824103817
NAIC Classification:	423300