401k Plan data: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN plan

CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN
Plan identification number	502

CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

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

Company Name: WOODWARD DESIGN BUILD LLC

Employer identification number (EIN): 720355450

NAIC Classification: 236200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01
502 2021-01-01
502 2020-01-01
502 2019-01-01
502 2018-01-01
502 2017-01-01 SEAN TYNAN SEAN TYNAN 2018-10-11
502 2016-01-01 MILENA DUPLANTIER MILENA DUPLANTIER 2017-08-10
502 2015-01-01 MILENA DUPLANTIER MILENA DUPLANTIER 2016-06-21
502 2014-01-01 MILENA DUPLANTIER MILENA DUPLANTIER 2015-05-13
502 2013-01-01 TERRY MCCUBBIN TERRY MCCUBBIN 2014-05-30
502 2012-01-01 TERRY MCCUBBIN TERRY MCCUBBIN 2013-10-11
502 2011-01-01 TERRY MCCUBBIN TERRY MCCUBBIN 2012-09-06
502 2010-01-01 TERRY MCCUBBIN TERRY MCCUBBIN 2011-08-26
502 2009-01-01 TERRY MCCUBBIN TERRY MCCUBBIN 2010-09-03

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2022-01-01
502	2021-01-01
502	2020-01-01
502	2019-01-01
502	2018-01-01
502	2017-01-01	SEAN TYNAN	SEAN TYNAN	2018-10-11
502	2016-01-01	MILENA DUPLANTIER	MILENA DUPLANTIER	2017-08-10
502	2015-01-01	MILENA DUPLANTIER	MILENA DUPLANTIER	2016-06-21
502	2014-01-01	MILENA DUPLANTIER	MILENA DUPLANTIER	2015-05-13
502	2013-01-01	TERRY MCCUBBIN	TERRY MCCUBBIN	2014-05-30
502	2012-01-01	TERRY MCCUBBIN	TERRY MCCUBBIN	2013-10-11
502	2011-01-01	TERRY MCCUBBIN	TERRY MCCUBBIN	2012-09-06
502	2010-01-01	TERRY MCCUBBIN	TERRY MCCUBBIN	2011-08-26
502	2009-01-01	TERRY MCCUBBIN	TERRY MCCUBBIN	2010-09-03

Plan Statistics for CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 182
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 145
Total of all active and inactive participants 2022-01-01 145
2021: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 197
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 182
Total of all active and inactive participants 2021-01-01 182
2020: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 257
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 197
Total of all active and inactive participants 2020-01-01 197
2019: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 177
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 257
Total of all active and inactive participants 2019-01-01 257
Total participants 2019-01-01 257
2018: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 177
Total of all active and inactive participants 2018-01-01 177
Total participants 2018-01-01 177
2017: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 72
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 151
Total of all active and inactive participants 2017-01-01 151
Total participants 2017-01-01 151
2016: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 72
Total of all active and inactive participants 2016-01-01 72
Total participants 2016-01-01 72
2015: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 213
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 152
Total of all active and inactive participants 2015-01-01 152
2014: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 227
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 213
Total of all active and inactive participants 2014-01-01 213
2013: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 245
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 227
Total of all active and inactive participants 2013-01-01 227
2012: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 246
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 245
Total of all active and inactive participants 2012-01-01 245
2011: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 396
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 455
Total of all active and inactive participants 2011-01-01 455
2010: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 370
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 396
Total of all active and inactive participants 2010-01-01 396
2009: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 301
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 370
Total of all active and inactive participants 2009-01-01 370

Measure	Date	Value
2022: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	182
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	145
Total of all active and inactive participants	2022-01-01	145
2021: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	197
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	182
Total of all active and inactive participants	2021-01-01	182
2020: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	257
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	197
Total of all active and inactive participants	2020-01-01	197
2019: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	177
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	257
Total of all active and inactive participants	2019-01-01	257
Total participants	2019-01-01	257
2018: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	177
Total of all active and inactive participants	2018-01-01	177
Total participants	2018-01-01	177
2017: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	72
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	151
Total of all active and inactive participants	2017-01-01	151
Total participants	2017-01-01	151
2016: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	72
Total of all active and inactive participants	2016-01-01	72
Total participants	2016-01-01	72
2015: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	213
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	152
Total of all active and inactive participants	2015-01-01	152
2014: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	227
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	213
Total of all active and inactive participants	2014-01-01	213
2013: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	245
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	227
Total of all active and inactive participants	2013-01-01	227
2012: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	246
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	245
Total of all active and inactive participants	2012-01-01	245
2011: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	396
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	455
Total of all active and inactive participants	2011-01-01	455
2010: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	370
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	396
Total of all active and inactive participants	2010-01-01	396
2009: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	301
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	370
Total of all active and inactive participants	2009-01-01	370

Form 5500 Responses for CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN

2022: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: CARL E. WOODWARD, LLC EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

Policy instance

Number of Individuals Covered	145
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $35,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

Policy instance

Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

944868

Policy instance

Insurance contract or identification number	944868
Number of Individuals Covered	145
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $309,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD132718

Policy instance

Insurance contract or identification number	LTD132718
Number of Individuals Covered	145
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-421440

Policy instance

Insurance contract or identification number	136-421440
Number of Individuals Covered	314
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $101,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD132718

Policy instance

Insurance contract or identification number	LTD132718
Number of Individuals Covered	218
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,339
Total amount of fees paid to insurance company	USD $1,690
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,339
Amount paid for insurance broker fees	1690
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

944868

Policy instance

Insurance contract or identification number	944868
Number of Individuals Covered	182
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $55,745
Total amount of fees paid to insurance company	USD $50,808
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $328,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,745
Insurance broker organization code?	3
Amount paid for insurance broker fees	50808

MEDCOM CARE MANAGEMENT, INC. (National Association of Insurance Commissioners NAIC id number: 52429 )

Policy contract number

Policy instance

Number of Individuals Covered	172
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,500
Total amount of fees paid to insurance company	USD $2,279
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,500
Insurance broker organization code?	3
Amount paid for insurance broker fees	2279

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

858787G

Policy instance

Insurance contract or identification number	858787G
Number of Individuals Covered	161
Insurance policy start date	2020-12-01
Insurance policy end date	2021-11-30
Total amount of commissions paid to insurance broker	USD $603
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $603
Insurance broker organization code?	3

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-421440

Policy instance

Insurance contract or identification number	136-421440
Number of Individuals Covered	352
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $11,441
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $114,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,441
Insurance broker organization code?	3

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

Policy instance

Number of Individuals Covered	172
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,565
Total amount of fees paid to insurance company	USD $5,072
Welfare Benefit Premiums Paid to Carrier	USD $32,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,565
Insurance broker organization code?	3
Amount paid for insurance broker fees	5072

HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	179
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $64,765
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,617,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,272
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	185
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $1,695
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,421
Insurance broker organization code?	3

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

Policy contract number

UB039

Policy instance

Insurance contract or identification number	UB039
Number of Individuals Covered	62
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $7,817
Total amount of fees paid to insurance company	USD $90
Other welfare benefits provided	CAFETERIA PLAN
Welfare Benefit Premiums Paid to Carrier	USD $69,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,707
Amount paid for insurance broker fees	32
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	165
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $9,852
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $109,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,253
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	214
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $8,517
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,152
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

858787G

Policy instance

Insurance contract or identification number	858787G
Number of Individuals Covered	161
Insurance policy start date	2019-12-01
Insurance policy end date	2020-11-30
Total amount of commissions paid to insurance broker	USD $7,673
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $51,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,673
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

858787G

Policy instance

Insurance contract or identification number	858787G
Number of Individuals Covered	157
Insurance policy start date	2018-12-01
Insurance policy end date	2019-11-30
Total amount of commissions paid to insurance broker	USD $5,646
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,641
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,646
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	146
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,181
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $101,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,181
Insurance broker organization code?	3

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

Policy contract number

UB039

Policy instance

Insurance contract or identification number	UB039
Number of Individuals Covered	65
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $10,375
Total amount of fees paid to insurance company	USD $642
Other welfare benefits provided	CAFETERIA PLAN
Welfare Benefit Premiums Paid to Carrier	USD $73,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,540
Amount paid for insurance broker fees	229
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	203
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $8,669
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,669
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	161
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $64,388
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,618,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64,388
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	168
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $1,719
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,719
Insurance broker organization code?	3

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	165
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,186
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,800
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	168
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,520
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,956
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,688
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

858787G

Policy instance

Insurance contract or identification number	858787G
Number of Individuals Covered	101
Insurance policy start date	2017-12-01
Insurance policy end date	2018-11-30
Total amount of commissions paid to insurance broker	USD $5,681
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,681
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	145
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $12,741
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $95,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,976
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

UB039

Policy instance

Insurance contract or identification number	UB039
Number of Individuals Covered	75
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $12,825
Total amount of fees paid to insurance company	USD $283
Other welfare benefits provided	CAFETERIA PLAN
Welfare Benefit Premiums Paid to Carrier	USD $73,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,572
Amount paid for insurance broker fees	90
Insurance broker organization code?	3

HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	167
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $63,736
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,601,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $63,736
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	155
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,643
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,643
Insurance broker organization code?	3
Insurance broker name	GILLIS ELLIS & BAKER, INC

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

Policy contract number

UB039

Policy instance

Insurance contract or identification number	UB039
Number of Individuals Covered	70
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $11,556
Total amount of fees paid to insurance company	USD $750
Other welfare benefits provided	CAFETERIA PLAN
Welfare Benefit Premiums Paid to Carrier	USD $66,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,044
Amount paid for insurance broker fees	268
Insurance broker organization code?	3
Insurance broker name	LYNNE HUDGINS MOORE

HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	132
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $9,380
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,192
Insurance broker organization code?	3
Insurance broker name	SOLDEVILA, DALE

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

858787G

Policy instance

Insurance contract or identification number	858787G
Number of Individuals Covered	112
Insurance policy start date	2016-12-01
Insurance policy end date	2017-11-30
Total amount of commissions paid to insurance broker	USD $5,416
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,416
Insurance broker organization code?	3
Insurance broker name	KING HALL & ASSOCIATES, INC.

HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	158
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,519
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,211
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,519
Insurance broker organization code?	3
Insurance broker name	GILLIS ELLIS & BAKER, INC

HUMANA (National Association of Insurance Commissioners NAIC id number: 95642 )

Policy contract number

600098

Policy instance

Insurance contract or identification number	600098
Number of Individuals Covered	158
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $57,374
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,437,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $57,374
Insurance broker organization code?	3
Insurance broker name	GILLIS ELLIS & BAKER, INC

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Company Name:	WOODWARD DESIGN BUILD LLC
Employer identification number (EIN):	720355450
NAIC Classification:	236200