401k Plan data: LINCOLN CREEK LUMBER CO., INC. MEDICAL PLAN plan

LINCOLN CREEK LUMBER CO., INC. MEDICAL PLAN 401k Plan overview

Plan Name	LINCOLN CREEK LUMBER CO., INC. MEDICAL PLAN
Plan identification number	501

LINCOLN CREEK LUMBER CO., INC. MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

LINCOLN CREEK LUMBER CO., INC. has sponsored the creation of one or more 401k plans.

Company Name: LINCOLN CREEK LUMBER CO., INC.

Employer identification number (EIN): 910844224

NAIC Classification: 444190
NAIC Description: Other Building Material Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LINCOLN CREEK LUMBER CO., INC. MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-04-01 TIFFINY HURST 2023-10-27

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-04-01	TIFFINY HURST	2023-10-27

Plan Statistics for LINCOLN CREEK LUMBER CO., INC. MEDICAL PLAN

401k plan membership statisitcs for LINCOLN CREEK LUMBER CO., INC. MEDICAL PLAN

Measure Date Value
2022: LINCOLN CREEK LUMBER CO., INC. MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year 2022-04-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 103
Number of retired or separated participants receiving benefits 2022-04-01 0
Number of other retired or separated participants entitled to future benefits 2022-04-01 0
Total of all active and inactive participants 2022-04-01 103
Number of employers contributing to the scheme 2022-04-01 0

Measure	Date	Value
2022: LINCOLN CREEK LUMBER CO., INC. MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year	2022-04-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	103
Number of retired or separated participants receiving benefits	2022-04-01	0
Number of other retired or separated participants entitled to future benefits	2022-04-01	0
Total of all active and inactive participants	2022-04-01	103
Number of employers contributing to the scheme	2022-04-01	0

Form 5500 Responses for LINCOLN CREEK LUMBER CO., INC. MEDICAL PLAN

2022: LINCOLN CREEK LUMBER CO., INC. MEDICAL PLAN 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	First time form 5500 has been submitted	Yes
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

6307400

Policy instance

Insurance contract or identification number	6307400
Number of Individuals Covered	109
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $31,813
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,058,008
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,813
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

2388600

Policy instance

Insurance contract or identification number	2388600
Number of Individuals Covered	15
Insurance policy start date	2022-04-01
Insurance policy end date	2023-03-31
Total amount of commissions paid to insurance broker	USD $3,256
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $108,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,256
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	LINCOLN CREEK LUMBER CO., INC.
Employer identification number (EIN):	910844224
NAIC Classification:	444190
NAIC Description:	Other Building Material Dealers