401k Plan data: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN plan

KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 401k Plan overview

Plan Name	KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN
Plan identification number	525

KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN Benefits

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

401k Sponsoring company profile

KOETTER WOODWORKING, INC has sponsored the creation of one or more 401k plans.

Company Name: KOETTER WOODWORKING, INC

Employer identification number (EIN): 351420041

NAIC Classification: 321900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
525 2022-01-01 TIMOTHY D. ENOS 2023-04-20
525 2021-01-01 JANE WISEMAN 2022-07-13
525 2020-01-01 BILL NETT 2021-06-03
525 2019-01-01 BILL NETT 2020-06-15
525 2018-01-01
525 2017-01-01
525 2016-01-01 LARRY BECKHAM
525 2015-01-01 LARRY BECKHAM
525 2014-01-01 STEPHEN C WHITLOW
525 2013-01-01 STEPHEN C WHITLOW
525 2012-01-01 STEPHEN C. WHITLOW
525 2011-01-01 STEPHEN C WHITLOW
525 2009-01-01 STEPHEN C. WHITLOW

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
525	2022-01-01	TIMOTHY D. ENOS	2023-04-20
525	2021-01-01	JANE WISEMAN	2022-07-13
525	2020-01-01	BILL NETT	2021-06-03
525	2019-01-01	BILL NETT	2020-06-15
525	2018-01-01
525	2017-01-01
525	2016-01-01	LARRY BECKHAM
525	2015-01-01	LARRY BECKHAM
525	2014-01-01	STEPHEN C WHITLOW
525	2013-01-01	STEPHEN C WHITLOW
525	2012-01-01	STEPHEN C. WHITLOW
525	2011-01-01	STEPHEN C WHITLOW
525	2009-01-01	STEPHEN C. WHITLOW

Plan Statistics for KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN

401k plan membership statisitcs for KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN

Measure Date Value
2022: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 258
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 258
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 258
Number of employers contributing to the scheme 2022-01-01 0
2021: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 232
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 258
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 258
Number of employers contributing to the scheme 2021-01-01 0
2020: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 246
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 232
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 232
Number of employers contributing to the scheme 2020-01-01 0
2019: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 237
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 246
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 246
Number of employers contributing to the scheme 2019-01-01 0
2018: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 220
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 237
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 237
Number of employers contributing to the scheme 2018-01-01 0
2017: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 220
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 220
2016: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 204
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 216
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 216
2015: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 184
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 204
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 204
2014: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 175
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 184
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 2014-01-01 184
2013: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 174
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 175
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 2013-01-01 175
2012: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 164
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 164
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 164
2011: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 164
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 164
2009: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 337
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 226
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 5
Total of all active and inactive participants 2009-01-01 231

Measure	Date	Value
2022: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	258
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	258
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	258
Number of employers contributing to the scheme	2022-01-01	0
2021: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	232
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	258
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	258
Number of employers contributing to the scheme	2021-01-01	0
2020: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	246
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	232
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	232
Number of employers contributing to the scheme	2020-01-01	0
2019: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	237
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	246
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	246
Number of employers contributing to the scheme	2019-01-01	0
2018: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	220
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	237
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	237
Number of employers contributing to the scheme	2018-01-01	0
2017: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	220
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	220
2016: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	204
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	216
Number of retired or separated participants receiving benefits	2016-01-01	0
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	216
2015: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	184
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	204
Number of retired or separated participants receiving benefits	2015-01-01	0
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	204
2014: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	175
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	184
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	184
2013: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	174
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	175
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	175
2012: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	164
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	164
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	164
2011: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	164
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	164
2009: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	337
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	226
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	5
Total of all active and inactive participants	2009-01-01	231

Form 5500 Responses for KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN

2022: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 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: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
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: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 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 – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
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 – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: KOETTER WOODWORKING, INC. MEDICAL WELFARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

BJ846

Policy instance

Insurance contract or identification number	BJ846
Number of Individuals Covered	40
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,319
Total amount of fees paid to insurance company	USD $211
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	No
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
Other welfare benefits provided	CANCER, RECOVERY
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 $39,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $4,319
Amount paid for insurance broker fees	211
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	SETH PENNINGTON AND VARIOUS AGENTS

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Company Name:	KOETTER WOODWORKING, INC
Employer identification number (EIN):	351420041
NAIC Classification:	321900