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ENROLL FOR 2024 BENEFITS At Mike Hooks LLC our employees are our most valuable asset That s why at Mike Hooks LLC we are committed to a comprehensive employee benefits program that helps our employees stay healthy feel secure and maintain a healthy work life balance One of the reasons we are an employer of choice is the rich benefits package we offer to our employees and their families As a Mike Hooks LLC employee you are fortunate to have a wide range of benefit programs available to you Benefits give you important financial protection when you need it the most We encourage you to take a close look at all of the benefit information provided in this guide so that you can make the choices that are right for you and your family Employees share in the cost of some of the benefits and Mike Hooks LLC provides other benefits at no cost to you life accidental death dismemberment and long term disability In addition there are voluntary benefits with reasonable group rates that eligible employees may elect to purchase through payroll deductions 2024 2025 BENEFITS OFFERED Medical Benefits Voluntary Dental Benefits Voluntary Vision Benefits Life and Accidental Death Dismemberment Benefits Voluntary Life and Accidental Death Dismemberment Benefits Voluntary Short Term Disability Employer Paid Long Term Disability Voluntary Accident Insurance Voluntary Critical Illness Insurance HOW TO ENROLL IN BENEFITS New hires can call 877 700 8136 or go to https calendly com unumengageplus mikehooks to schedule an appointment to speak with an enroller OPEN ENROLLMENT PEROID FOR BENEFIT YEAR 2024 2025 WILL BEGIN ON APRIL 1 2024 AND END ON APRIL 12 2024 Monday Friday ENGLISH AND SPANISH SPEAKING ENROLLERS WILL BE AVAILABLE FROM 7 00 AM TO 7 00 PM CST YOU CAN CALL TO SPEAK TO A COUNSELOR DIRECTLY AT 877 700 8136 OR GO TO https calendly com unumengageplus mikehooks TO SCHEDULE AN APPOINTMENT TO SPEAK WITH AN ENROLLER YOU MAY ALSO SCAN THE QR CODE FOR THE SCHEDULING LINK PLEASE HAVE DENENDENTS AND BENEFICIARY NAMES DATE OF BIRTHS AND SOCIAL SECURITY NUMBERS WHEN SPEAKING TO AN ENROLLER

ENROLL FOR 2024 BENEFITS OPEN ENROLLMENT PERIOD APRIL 1ST 12TH BENEFITS EFFECTIVE MAY 1ST ELIGIBILITY If you are a Newly Hired Employee who has worked at least 30 hours per week and have satisfied the companydefined waiting period which is first of the month following 60 days of employment you and your legal dependents are eligible for Mike Hooks LLC benefits If you elect benefits within 60 days following your eligibility date your elected benefits will become effective on the first billing date following If you are a Current Benefits Eligible Employee each year you have the opportunity to review your benefit elections during the benefits annual open enrollment period During this time you can change plans add drop coverage or add drop dependents from coverage If you do not elect coverage upon initial eligibility or during open enrollment you will not be able to add or change benefits unless you have a qualifying life event special enrollment Elections made during open enrollment will remain until the next open enrollment unless you or your family members experience a qualifying life event If you experience a qualifying life event you must contact Human Resources within 30 days See below examples of qualifying events Please note Eligible dependents are your legal spouse children under age 26 and disabled dependents of any age QUALIFYING EVENTS The IRS provides strict regulations about changes to pre tax elections during the plan year If you experience a qualified IRS family status change mid year you are permitted to make changes within 30 days of the event If the change request is not completed within 30 days of the event you will not be able to change your elections until the following year s benefits annual open enrollment period Below is a list of some of the more commonly known qualified family status changes Marriage divorce or annulment Birth of a child adoption or legal guardianship of a child or court ordered coverage of your child Loss of coverage Death of a dependent This document is an outline of the coverage proposed by the carrier s based on information provided by your company It does not include all of the terms coverage exclusions limitations and conditions of the actual contract language The policies and contracts themselves must be read for those details Policy forms for your reference will be made available upon request The intent of this document is to provide you with general information regarding the status of and or potential concerns related to your current employee benefits environment It does not necessarily fully address all of your specific issues It should not be construed as nor is it intended to provide legal advice Questions regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area

MEDICAL BENEFITS Administered by United Health Care Mike Hooks LLC offers comprehensive medical coverage to protect you and your family from catastrophic medical costs Comprehensive and preventive healthcare coverage is important in protecting you and your family from the financial risks of unexpected illness and injury Routine exams and regular preventive care provide an inexpensive review of your health Small problems can potentially develop into large expenses By identifying the problems early often they can be treated at little cost UMR UNITED HEALTHCARE CHOICE PLUS NETWORK In Network Out of Network Lifetime Benefit Maximum Annual Deductible Annual Out of Pocket Maximum includes deductible Unlimited 1 000 Individual 2 000 Family 3 000 Individual 6 000 Family Unlimited 2 000 Individual 4 000 Family 6 000 Individual 10 000 Family Employee Coinsurance 20 40 TELEDOC SERVICES GENERAL MEDICINE AND BEHAVIORAL HEALTH VISIT OFFICE VISITS 10 Copay Primary Care Office Visit 20 after deductible 40 after deductible Specialist Office Visit 20 after deductible 40 after deductible Preventive Care screening immunization Diagnostic Test x ray blood work PA may be required Imaging CT PET scans MRIs PA IS required No cost to the member 20 after deductible 20 after deductible 40 after deductible 40 after deductible 40 after deductible PRESCRIPTION DRUGS LIMITATIONS EXCEPTIONS CONDITIONS MAY APPLY Prescription Deductible and Out of Pocket Max is Integrated with Medical All Tiers PA may be required EMERGENCY SERVICES 20 after deductible 40 after deductible Emergency Room 500 copay waived if admitted 20 after deductible Inpatient Surgery and Care 20 after deductible 40 after deductible Outpatient Surgery and Care 20 after deductible 40 after deductible Urgent Care Ambulance and Other Medical Necessary Transportation 20 after deductible 20 after deductible 40 after deductible 40 after deductible Deductibles and copays apply to our of pocket maximum See Summary of Benefits for further details of the plan Services rendered out of network are subject to a higher deductible out of pocket amount and coinsurance percentage Members who seek treatment out ofnetwork will inquire higher out of pocket expenses Members will also be responsible for any over reasonable and customary charges This is only an outline All benefits are subject to the terms and conditions of the Contract In the case of a discrepancy the Contract will prevail

MEDICAL BENEFITS Rates and Contributions See below for your medical rates

24 7 doctor visits via phone or mobile app Teladoc gives you round the clock access to U S boardcertifed doctors from home or on the go Call or connect online or using the Teladoc mobile app for afordable medical care when you need it So many rea to use Tela Talk to a doctor anytime anywhere you happen to be Receive quality care via phone video or mobile app Prompt treatment median call back in 10 minutes A network of doctors that can treat every member of the family Prescriptions sent to pharmacy of choice if medically necessary Teladoc is less expensive than the ER or urgent care Get the care you need Teladoc doctors can treat many medical conditions including Cold fu symptoms Allergies Pink eye Respiratory infections Sinus problems Skin problems And more With your consent Teladoc is happy to provide information about your Teladoc visit to your primary care physician 2020 United HealthCare Services Inc UM1342 0520 UA No part of this document may be reproduced without permission Talk to a doctor anytime visit Teladoc com Teladoc goivrecsalyl ou access docto1r 8th00ro Tueglahdtohce conve It s an affordable option fo 1 2 Talk to a doctor anytime anywhere you happen to be 4 5 A network of doctors that can treat every member of the family Talk to a doctor

Peace of mind happens here Speak with a licensed therapist from anywhere Taking care of your mental health is an important part of your overall well being With Teladoc s Mental Health adults 18 and older can get care for anxiety depression grief family issues and more Choose to see a psychiatrist psychologist social worker or therapist and establish an ongoing relationship As a working mom with two small children having easy access to an amazing psychologist Ade O Teladoc member Why use Teladoc s Mental Health service Convenience to speak with a therapist from anywhere Flexible scheduling Quick access to the right provider for you Confidential therapy on your terms Teladoc com Download the app 2020 Teladoc Health Inc All rights reserved Teladoc and the Teladoc logo are registered trademarks of Teladoc Health Inc and may not be used without written permission Teladoc does not replace the primary care physician Teladoc does not guarantee that a prescription will be written Teladoc operates subject to state regulation and may not be available in certain states Teladoc does not prescribe DEA controlled substances non therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse Teladoc physicians reserve the right to deny care for potential misuse of services 231579237 _06202018

Have you filled out your medical history yet Why a confidential medical history is important Before you speak with a Teladoc doctor they ll want to know about any past or current illnesses as well as current medications and family history Teladoc is HIPAA compliant and all information is confidential Your company cannot view your medical history With your consent Teladoc will share details of your visit with your primary care doctor Once you ve completed your medical history you ll be ready to talk to a doctor for 49 or less Complete your medical history at Teladoc com Log in to the Teladoc website and complete My Medical History Download the app Log in to your account and complete Medical History section 1 800 TELADOC 835 2362 Speak to a customer service rep for help 2020 Teladoc Health Inc All rights reserved Teladoc and the Teladoc logo are registered trademarks of Teladoc Health Inc and may not be used without written permission Teladoc does not replace the primary care physician Teladoc does not guarantee that a prescription will be written Teladoc operates subject to state regulation and may not be available in certain states Teladoc does not prescribe DEA controlled substances non therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse Teladoc physicians reserve the right to deny care for potential misuse of services 10E_131B_05032018

VOLUNTARY DENTAL BENEFITS Administered by Unum Good oral care enhances overall physical health appearance and mental well being Problems with the teeth and gums are common and easily treated health problems Dental insurance helps pay for all or a portion of the costs associated with dental care from routine cleanings to root canals COVERAGE TYPE Annual Deductible Applies to Basic and Major Services IN NETWORK 50 per person 150 family Annual Benefit Maximum 1 500 Preventive Services Routine Exams 2 per 12 months Prophylaxis 2 per 12 months 1 additional cleaning or periodontal maintenance per 12 months if member is in 2nd or 3rd trimester of pregnancy Bitewing x rays max 4 films 1 per 12 months Full mouth x ray 1 per 36 months Fluoride to age 16 1 per 12 months Sealants to age 16 permanent molars 1 per 36 months Adjunctive pre diagnostic oral cancer screening 1 per 12 months for ages 40 Upon eligibility no waiting period Basic Dental Services Emergency pain 1 per 12 months Space maintainers Fillings benefit allowed for amalgam restorations on posterior teeth Simple extractions Non surgical periodontics Endodontics root canals Surgical periodontics gum treatments Upon eligibility no waiting period Major Dental Services Anesthesia subject to review covered with complex oral surgery Oral surgery surgical extractions impactions Inlays Onlays Crowns Bridges Dentures and implants Repairs crown denture and bridges Upon eligibility no waiting period 100 80 after deductible 50 after deductible Orthodontia Services Deductible waived coverage for dependent children before age 19 Upon eligibility no waiting period 50 to 1 500 lifetime maximum In Network Benefits refer to benefits provided under this plan for covered dental services that are provided by a participating dentist In Network follows fee schedule If services are rendered by an Out of Network provider you may have additional expenses out of pocket When care is rendered by an out of network provider benefits will be based on the 90th percentile of the usual and customary charges You can receive a list of participating dental providers online at www unum com employees benefits dental insurance or by calling 1 866 679 3054 to have a list faxed or mailed to you If your current dentist does not participate in the network and you would like to encourage him or her to apply ask your dentist to visit www unum com employees benefits dental insurance or call 1 866 679 3054 for an application Please note the website and phone number are for use by dental professionals only This is only an outline All benefits are subject to the terms and conditions of the Contract In the case of a discrepancy the Contract will prevail

VOLUNTARY VISION BENEFITS AAdmdminiinsitsetreerdedbby yPUrincuimpal Regular eye examinations can not only determine your need for corrective eyewear but also may detect general health problems in their earliest stages Protection for the eyes should be a major concern to everyone SERVICE Eye Exam once every 12 months LENSES ONCE EVERY 12 MONTHS IN NETWORK ANY UNUM VISION CARE PROVIDER 10 copay OUT OF NETWORK ANY QUALIFIED NON NETWORK PROVIDER OF YOUR CHOICE Up to 35 Single Vision Lenses 10 copay Up to 25 Bifocal Lenses Trifocal Lenses Lenticular Lenses 10 copay 10 copay Up to 80 Up to 40 Up to 50 Up to 50 Frames once every 24 months Up to 130 CONTACT LENSES ONCE EVERY 12 MONTHS IF YOU ELECT CONTACTS INSTEAD OF LENSES FRAMES Elective Contacts Up to 130 Medically Necessary Up to 210 Up to 50 Up to 100 Up to 210 Fitting and Evaluation 25 copay N A When you receive care from an in network vision provider your cost may be lower Network providers agree to lower their fees To locate a vision network provider near you visit www UnumVisionCare com When care is rendered by an out of network provider the member will incur higher out of pocket expenses Some providers may charge for a contact fit and evaluation separately from your contact lens allowance leaving the entire allowance for materials This is only an outline All benefits are subject to the terms and conditions of the contract In the case of a discrepancy the contract will prevail 7

GROUP TERM LIFE EMPLOYER PAID BASIC LIFE AND ACCIDENTAL DEATH DISMEMBERMENT INSURANCE Administered by Unum Life insurance provides financial security for the people who depend on you Mike Hooks LLC provides all eligible full time employees company paid Basic Life and Accidental Death Dismemberment AD D coverage Both are a 50 000 benefit at no cost to full time eligible employees Your beneficiary beneficiaries will receive a lump sum payment if you die while employed by Mike Hooks LLC You must elect a beneficiary Your beneficiary is the person s who will receive your life insurance benefit when you are deceased Your beneficiary can be one person or multiple people charitable institutions or your estate Once named your beneficiary remains on file until you make a change Changes can be made at any time If your family situation changes you will want to review the beneficiary beneficiaries listed on file and make updates as necessary Please see Human Resources for any updates to beneficiary beneficiaries Note Benefits reduce to 65 at age 65 45 at age 70 30 at age 75 and 20 at age 80 Portability options are available See Human Resources for details Benefits will not be paid for accidental losses caused by contributed to by or resulting from Suicide self destruction while sane intentionally self inflicted injury while sane or self inflicted injury while sane or self inflicted injury while insane Active participation in a riot Attempt to commit or commission of a crime War declared or undeclared or any act of war Use of any prescription or non prescription drug poison fume or other chemical substance unless used according to the prescription or direction of the employee s physician This exclusion does not apply if the chemical substance is ethanol Disease of the body or diagnostic medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders

GROUP TERM LIFE VOLUNTARY LIFE AND ACCIDENTAL DEATH DISMEMBERMENT INSURANCE Administered by Unum Mike Hooks LLC provides all full time eligible employees the opportunity to purchase additional Life Insurance and Accidental Death Dismemberment AD D coverage If you purchase coverage on yourself you can also purchase coverage for your legal dependents The chart below shows the coverage available If you and or your spouse do not apply for benefits when you are initially eligible for coverage evidence of insurability proof of good health will be required Employee Spouse Child Overall Benefit Maximum Minimum Increments Amount Non Medical Maximum The lesser of 5 x s your basic annual earnings or 500 000 10 000 80 000 The lesser of 100 of the Employee Life amount or 250 000 5 000 25 000 The lesser of 100 of the Employee Life amount or 10 000 Live birth to 6 months 1 000 6 months to 19 years 2 000 increments up to 10 000 10 000 Annual Increase without Medical Questions AD D Maximum 10K per year up to non medical maximum Same as Life amount 10K per year up to non medical maximum Same as Life amount N A Same as Life amount Reduction Formula 65 at age 70 and 50 at age 75 65 at age 70 and 50 at age 75 based on EE age Terms at age 19 For purposes of calculating benefits and cost an employee s annual earnings is assumed to mean gross annual income before taxes including any pre tax contributions to a deferred compensation plan excluding commissions bonuses overtime pay or other extra compensation Portability and Conversion options are available See Humana Resources for details 24 month suicide exclusion Benefits will not be paid for accidental losses caused by contributed to by or resulting from Suicide self destruction while sane intentionally self inflicted injury while sane or self inflicted injury while sane or self inflicted injury while insane Active participation in a riot Attempt to commit or commission of a crime War declared or undeclared or any act of war Use of any prescription or non prescription drug poison fume or other chemical substance unless used according to the prescription or direction of the employee s physician This exclusion does not apply if the chemical substance is ethanol Disease of the body or diagnostic medical or surgical treatment or mental 9 disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders Being intoxicated

DISABILITY INSURANCE Voluntary Short Term Disability Administered by Unum Mike Hooks LLC provides voluntary Short Term Disability coverage for purchase through Unum The full cost of this coverage would be EMPLOYEE paid This coverage provides a benefit beginning at the end of the elimination period and continues while you are disabled due to an injury or sickness to the maximum benefit duration If you do not apply for benefits when you are initially eligible for coverage evidence of insurability proof of good health will be required to enroll in Short Term Disability Benefits Begin Short Term Disability Plan Highlights Coverage begins on the 15th consecutive day of disability Maximum Benefit Duration Benefits are available up to 11 weeks Weekly Benefit Amount 60 of your covered earnings up to a maximum of 1 250 per week Pre Existing 3 12 if disability begins in the first 12 months after the effective date and you received care during the 3 months prior to the effective date of coverage the disability is considered pre existing This is an estimate of premium cost Actual deductions may vary slightly due to rounding and payroll frequency

DISABILITY INSURANCE Employer Paid Long Term Disability Administered by Unum Mike Hooks LLC provides employer paid Long Term Disability coverage for purchase through Unum The full cost of this coverage would be EMPLOYER paid This coverage provides a benefit beginning at the end of the elimination period and continues while you are disabled due to an injury or sickness to the maximum benefit duration Long Term Disability Plan Highlights Maximum Monthly Benefit 6 000 per month Benefit Percentage 60 of your covered earnings Waiting Period Coverage begins on the 91st consecutive day of total disability Benefit Duration Pre Existing Social Security Retirement Age Reducing Benefit Duration 3 12 if disability begins in the first 12 months after the effective date and you received care during the 3 months prior to the effective date of coverage the disability is considered pre existing

VOLUNTARY CRITICAL ILLNESS Mike Hooks LLC makes available to every eligible employee a voluntary critical illness policy Many major illnesses can be financially devastating While comprehensive medical insurance is designed to assist with the cost of treatment Unum s supplemental Critical Illness policy pays a policyholder direct to assist with out of pocket expenses by providing a lump sum benefit that can be used at the policyholder s discretion The full cost of this coverage would be EMPLOYEE paid If you and or your spouse do not apply for benefits when you are initially eligible for coverage evidence of insurability proof of good health will be required Employee Benefits Spouse Benefits Child Benefits Scheduled Benefit 10 000 increments 10 000 increments 50 of approved employee amount Minimum Benefit 10 000 5 000 1 250 Maximum Benefit 30 000 50 of employee amount 50 of employee amount Guarantee Issue 30 000 15 000 15 000 Lifetime Maximum Benefit Subsequent Occurrence Benefit Recurrence Benefit Covered Illnesses Benefit Wellness Benefit Portability 100 of the amount of insurance 100 of benefit 3 months End Stage Renal Kidney Failure 100 of benefit 6 months Heart Attack Major Organ Failure Requiring Transplant Stroke Coronary Artery Disease Major 100 100 100 100 50 Coronary Artery Disease Minor 10 Additional Benefits 50 Health Screening If you cease to qualify as a member you may be able to continue coverage for you your covered dependents

VOLUNTARY CRITICAL ILLNESS

VOLUNTARY ACCIDENT INSURANCE Administered by Unum At times unfortunate accidents can occur as a result of a simple mishap While comprehensive medical insurance is designed to cover the treatment of an accident Unum s accident policy can assist you with out ofpocket cost by providing benefits paid directly to you The full cost of this coverage would be EMPLOYEE paid COVERAGE Ambulance Transportation Emergency Treatment Diagnostic Examination X Rays Physician Office Visit Epidural Anesthesia Injections Initial Hospital Admission Initial ICU Hospital Admission Hospital Confinement per day ICU Confinement per day Rehabilitation Facility Confinement Chiropractic Services Transportation OFF THE JOB ONLY 24 HR WELLNESS BENEFIT 50 300 Ground 1 000 Air 200 200 per CT MRI scan 50 75 initial 75 follow up 100 1 000 1 000 200 365 days max 400 30 days max 100 day 20 per session 100 Lodging Paralysis Benefits 150 per night 25 000 quadriplegia 12 500 paraplegia hemiplegia Surgery Benefits Medical Appliance Organized Youth Sport Benefit Prosthesis Physical Therapy 150 Exploratory 750 for Knee Cartilage 1 500 for Abdominal Thoracic 1 000 for Ruptured Disc 150 10 1 500 for two or more 750 for one 20 per session Fractures Dislocations Burns Coma Concussion Dental Injury Eye Injury Lacerations Portability Up to 7 500 for certain surgical repair Up to 3 750 for non surgical Chip 25 of non surgical benefit Multiple 100 of highest sustained fracture Up to 2 400 for non surgical Up to 4 800 for surgical Partial 25 of full dislocation Multiple 100 of highest dislocation benefit Up to 1 000 for 2nd degree burns Up to 10 00 for 3rd degree burns Skin Graft 50 of benefit payable for Burns 5 000 200 350for Crown 115 for Extraction 200 for removal of foreign object 300 for surgical repair Up to 600 Included Further Accident coverage and details can be found in the full certificate See Human Resources Employee Only 2 33 Employee Weekly Premiums Employee Spouse Employee Child ren 4 26 14 6 11 Employee Family 8 04

Learn more about your annual Be Well Benefit MIKE HOOKS LLC Your Unum plan pays a Be Well Benefit for one Be Well screening each year With Unum s Be Well Benefit you and other covered family members can receive a valuable incentive for important tests and screenings Many of these tests are routinely performed so it s easy to take advantage of this benefit Your Critical Illness Be Well benefit is tied to the coverage amount you choose For instance if you choose a coverage amount of 10 000 your Be Well benefit will be 50 A coverage amount of 30 000 will have a Be Well benefit of 100 Your Accident Be Well benefit is 50 BE WELL SCREENINGS Annual exams by a physician including sports physicals and well child visits dental and vision exams Cancer screenings including pap smear colonoscopy Cardiovascular function screenings Cholesterol and diabetes screenings Imaging studies including chest X ray mammography Immunizations including HPV MMR tetanus influenza IT S EASY TO FILE A CLAIM You can receive a benefit for tests that are performed after your initial coverage date Follow these simple steps File your claim online with a one time registration on unum com by mail or over the phone Simply call 1 800 635 5597 to learn more You will need to provide the following First and last names of the employee and claimant the employee might not be the claimant Employee s Social Security number or policy number Name and date of the test Name of physician and the facility where the test was performed Each year you can earn a valuable incentive just for taking care of your health And so can each of your covered family members unum com For more information please contact your HR representative Unum will pay Be Well benefits for all eligible policies according to policy terms THESE POLICIES OFFER LIMITED BENEFITS The policies or their provisions may vary or be unavailable in some states The policies have exclusions and limitations which may affect any benefits payable See the actual policy or your Unum representative for specific provisions and details of availability In New Hampshire Be Well is referred to as Health Screening In Washington Be Well on the Accident product is referred to as Health Screening Benefit rider In Kansas Be Well is not available on the Hospital product and immunizations are not covered on the Accident or Critical Illness products Underwritten by Unum Insurance Company Portland Maine In New Jersey and New York underwritten by Provident Life and Casualty Insurance Company Chattanooga Tennessee 2022 Unum Group All rights reserved Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries EN 1911 BeWell FOR EMPLOYEES 11 22

Help when you need it most With your Employee Assistance Program and Work Life Balance services confidential assistance is as close as your phone or computer Always by your side Expert support 24 7 Convenient website Short term help Referrals for additional care Monthly webinars Medical Bill SaverTM helps you save on medical bills Who is covered Unum s EAP services are available at NO COST to all full time eligible employees their spouses dependent children parents and parents in law MIKE HOOKS LLC Employee Assistance Program EAP Your EAP is designed to help you lead a happier and more productive life at home and at work Call for confidential access to a Licensed Professional Counselor who can help you A Licensed Professional Counselor can help you with Stress depression anxiety Relationship issues divorce Job stress work conflicts Family and parenting problems Anger grief and loss And more Work Life Balance You can also reach out to a specialist for help with balancing work and life issues Just call and one of our Work Life Specialists can answer your questions and help you find resources in your community Ask our Work Life Specialists about Child care Elder care Legal questions Identity theft Financial services debt management credit report issues Even reducing your medical dental bills And more Help is easy to access Online phone support Unlimited confidential 24 7 In person You can get up to 3 visits available at no additional cost to you with a Licensed Professional Counselor Your counselor may refer you to resources in your community for ongoing support Secure HIPAA compliant video EAP sessions for those who may prefer the use of technology to receive the service video counseling services are in lieu of face to face sessions Employee Assistance Program Work Life Balance Toll free 24 7 access 1 800 854 1446 multi lingual www unum com lifebalance Turn to us when you don t know where to turn The counselors must abide by federal regulations regarding duty to warn of harm to self or others In these instances the consultant may be mandated to report a situation to the appropriate authority Unum s Employee Assistance Program and Work Life Balance services provided by HealthAdvocate are available with select Unum insurance offerings Terms and availability of service are subject to change Service provider does not provide legal advice please consult your attorney for guidance EN 2055 2 22 FOR EMPLOYEES Services are not valid after coverage terminates Please contact your Unum representative for details Insurance products are underwritten by the subsidiaries of Unum Group unum com 2022 Unum Group All rights reserved Unum is a registered trademark and marketing brand of Unum Group and its insuring subsidiaries

CONTACT INFORMATION If you have specific questions about a benefit plan please contact the administrator listed below or your local human resources department BENEFIT Medical Voluntary Dental Voluntary Vision Life and AD D Voluntary Life and AD D STD and LTD Accident Critical Illness Human Resources Gallagher Benefit Services Enrollment Team ADMINISTRATOR United Health Care Unum Unum Unum Unum Unum Unum Dana Taylor Matthew Ardoin Enrollers UNUM PHONE 1 800 801 4409 1 800 275 8686 1 800 275 8686 1 800 275 8686 1 800 275 8686 1 800 275 8686 1 800 275 8686 337 436 6693 337 278 5474 877 700 8136 WEBSITE EMAIL www uhc com www unum com www unum com www unum com www unum com www unum com www unum com dtaylor mikehooks com Matthew_Ardoin ajg com https calendly com unumengageplus mikehooks

This benefit summary prepared by This document is an outline of the coverage provided under your employer s benefit plans based on information provided by your company It does not include all the terms coverage exclusions limitations and conditions contained in the official Plan Document applicable insurance policies and contracts collectively the plan documents The plan documents themselves must be read for those details The intent of this document is to provide you with general information about your employer s benefit plans It does not necessarily address all the specific issues which may be applicable to you It should not be construed as nor is it intended to provide legal advice To the extent that any of the information contained in this document is inconsistent with the plan documents the provisions set forth in the plan documents will govern in all cases If you wish to review the plan documents or you have questions regarding specific issues or plan provisions you should contact your Human Resources Benefits Department 2024 Gallagher Benefit Services Inc All rights reserved Bolton Ford

Summary of Benefits and Coverage What this Plan Covers What You Pay for Covered Services UMR MIKE HOOKS LLC 7670 00 416153 001 Coverage Period 05 01 2024 04 30 2025 Coverage for Individual Family Plan Type PPO The Summary of Benefits and Coverage SBC document will help you choose a health plan The SBC shows you how you and the plan would share the cost for covered health care services NOTE Information about the cost of this plan called the premium will be provided separately This is only a summary For more information about your coverage or to get a copy of the complete terms of coverage visit www umr com or by calling 1 800 826 9781 For general definitions of common terms such as allowed amount balance billing coinsurance copayment deductible provider or other underlined terms see the Glossary You can view the Glossary at www umr com or call 1 800 826 9781 to request a copy Important Questions What is the overall deductible Answers 1 000 person 2 000 family In network 2 000 person 4 000 family Out of network Are there services covered before you meet your deductible Yes Preventive care services are covered before you meet your deductible Are there other deductibles for specific No services What is the out of pocket 3 000 person 6 000 family In network limit for this plan 6 000 person 10 000 family Out of network What is not included in Penalties premiums balance billing charges the out of pocket limit and health care this plan doesn t cover Will you pay less if you Yes See www umr com or call use a network provider 1 800 826 9781 for a list of network providers Do you need a referral to see a specialist No Why this Matters Generally you must pay all the costs from providers up to the deductible amount before this plan begins to pay If you have other family members on the plan each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible This plan covers some items and services even if you haven t yet met the deductible amount But a copayment or coinsurance may apply For example this plan covers certain preventive services without cost sharing and before you meet your deductible See a list of covered preventive services at https www healthcare gov coverage preventive care benefits You don t have to meet deductibles for specific services The out of pocket limit is the most you could pay in a year for covered services If you have other family members in this plan they have to meet their own out of pocket limits until the overall family out of pocket limit has been met Even though you pay these expenses they don t count toward the out of pocket limit This plan uses a provider network You will pay less if you use a provider in the plan s network You will pay the most if you use an out of network provider and you might receive a bill from a provider for the difference between the provider s charge and what your plan pays balance billing Be aware your network provider might use an out of network provider for some services such as lab work Check with your provider before you get services You can see the specialist you choose without a referral Page 1 of 7

All copayment and coinsurance costs shown in this chart are after your deductible has been met if a deductible applies Common Medical Event Services You May Need What You Will Pay In network You will pay the least Out of network You will pay the most Limitations Exceptions Other Important Information Primary care visit to treat an injury or illness 20 Coinsurance 40 Coinsurance None If you visit a health care provider s office or clinic Specialist visit Preventive care screening immunization 20 Coinsurance 40 Coinsurance No charge Deductible Waived 40 Coinsurance None You may have to pay for services that aren t preventive Ask your provider if the services needed are preventive Then check what your plan will pay for Diagnostic test x ray blood work 20 Coinsurance If you have a test Imaging CT PET scans MRIs 20 Coinsurance 40 Coinsurance 40 Coinsurance None None Page 2 of 7

Common Medical Event Services You May Need If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www umr com Tier 1 generic and some brandname Tier 2 preferred brand name and some generic Tier 3 nonpreferred brand name and nonpreferred generic Tier 4 specialty drugs If you have outpatient surgery Facility fee e g ambulatory surgery center Physician surgeon fees What You Will Pay In network You will pay the least Out of network You will pay the most 20 Copay 20 Copay 20 Copay If you use a Non Network Pharmacy you are responsible for payment upfront You may be reimbursed based on the lowest contracted amount minus any applicable deductible or copayment amount 20 Copay Limitations Exceptions Other Important Information Deductible and Out of pocket limit applies Covers up to a 30 day supply retail 31 90 day supply mail order Covers up to a 30 day supply specialty You must pay the difference in cost between a Generic drug and Brandname drug when a medical professional has not specified a Brand name drug or has not indicated that the Brand name drug is necessary this difference is not applied to preferred brand name products in the high priced generic strategy until the out of pocket is met 20 Coinsurance 40 Coinsurance None 20 Coinsurance 40 Coinsurance None If you need immediate medical attention Emergency room care 500 Copay per visit 20 Coinsurance Emergency medical transportation 20 Coinsurance Urgent care 20 Coinsurance 500 Copay per visit 20 Coinsurance 20 Coinsurance 40 Coinsurance In network deductible applies to Out of network benefits Copay may be waived if admitted In network deductible applies to Out of network benefits None Page 3 of 7

Common Medical Event Services You May Need What You Will Pay In network You will pay the least Out of network You will pay the most Limitations Exceptions Other Important Information If you have a hospital stay Facility fee e g hospital room Physician surgeon fees 20 Coinsurance 20 Coinsurance 40 Coinsurance 40 Coinsurance If you have mental health behavioral health or substance abuse services Outpatient services Inpatient services 20 Coinsurance 20 Coinsurance 40 Coinsurance 40 Coinsurance Office visits No charge Deductible Waived 40 Coinsurance If you are pregnant Childbirth delivery professional services 20 Coinsurance 40 Coinsurance Childbirth delivery facility services 20 Coinsurance 40 Coinsurance Preauthorization is required If you don t get preauthorization benefits could be reduced by 300 of the total cost of the service for Out of network Preauthorization is required for Partial hospitalization If you don t get preauthorization benefits could be reduced by 300 of the total cost of the service for Out of network Preauthorization is required If you don t get preauthorization benefits could be reduced by 300 of the total cos of the service for Out of network Cost sharing does not apply for preventive services Depending on the type of services deductible copayment or coinsurance may apply Maternity care may include tests and services described elsewhere in the SBC i e ultrasound Page 4 of 7

Common Medical Event Services You May Need Home health care Rehabilitation services If you need help recovering or have other special health needs Habilitation services Skilled nursing care Durable medical equipment Hospice service If your child needs dental or eye care Children s eye exam Children s glasses Children s dental check up What You Will Pay In network You will pay the least Out of network You will pay the most 20 Coinsurance 40 Coinsurance 20 Coinsurance 40 Coinsurance Limitations Exceptions Other Important Information 90 Maximum visits per calendar year Preauthorization is required If you don t get preauthorization benefits could be reduced by 300 of the total cost of the service for Out of network None 20 Coinsurance 20 Coinsurance 20 Coinsurance 20 Coinsurance 40 Coinsurance 40 Coinsurance 40 Coinsurance 40 Coinsurance None 90 Maximum days per calendar year Preauthorization is required If you don t get preauthorization benefits could be reduced by 300 of the total cost of the service for Out of network Preauthorization is required for DME in excess of 500 for rentals or 1 500 for purchases If you don t get preauthorization benefits could be reduced by 300 per occurrence for Out of network None Not covered Not covered None Not covered Not covered None Not covered Not covered None Page 5 of 7

Excluded Services Other Covered Services Services Your Plan Does NOT Cover Check your policy or plan document for more information and a list of any other excluded services Acupuncture Cosmetic surgery Dental care Adult Infertility treatment Long term care Non emergency care when traveling outside the U S Routine eye care Adult Routine foot care Weight loss programs Other Covered Services Limitations may apply to these services This isn t a complete list Please see your plan document Bariatric surgery Chiropractic care Hearing aids to age 18 Private duty nursing Outpatient care Your Rights to Continue Coverage There are agencies that can help if you want to continue your coverage after it ends The contact information for those agencies is U S Department of Labor s Employee Benefits Security Administration at 1 866 444 EBSA 3272 or www HealthCare gov Other coverage options may be available to you too including buying individual insurance coverage through the Health Insurance Marketplace For more information about the Marketplace visit www HealthCare gov or call 1 800 318 2596 Your Grievance and Appeals Rights There are agencies that can help if you have a complaint against your plan for a denial of a claim This complaint is called a grievance or appeal For more information about your rights look at the explanation of benefits you will receive for that medical claim Your plan documents also provide complete information to submit a claim appeal or a grievance for any reason to your plan For more information about your rights this notice or assistance contact U S Department of Labor s Employee Benefits Security Administration at 1 866 444 EBSA 3272 or www HealthCare gov Additionally a consumer assistance program may help you file your appeal A list of states with Consumer Assistance Programs is available at www HealthCare gov and http cciio cms gov programs consumer capgrants index html Does this plan Provide Minimum Essential Coverage Yes Minimum Essential Coverage generally includes plans health insurance available through the Marketplace or other individual market policies Medicare Medicaid CHIP TRICARE and certain other coverage If you are eligible for certain types of Minimum Essential Coverage you may not be eligible for the premium tax credit Does this plan Meet the Minimum Value Standard Yes If your plan doesn t meet the Minimum Value Standards you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace To see examples of how this plan might cover costs for a sample medical situation see the next section Page 6 of 7

About these Coverage Examples This is not a cost estimator Treatments shown are just examples of how this plan might cover medical care Your actual costs will be different depending on the actual care you receive the prices your providers charge and many other factors Focus on the cost sharing amounts deductibles copayments and coinsurance and excluded services under the plan Use this information to compare the portion of costs you might pay under different health plans Please note these coverage examples are based on self only coverage Peg is Having a Baby 9 months of in network pre natal care and a hospital delivery Managing Joe s Type 2 Diabetes a year of routine in network care of a wellcontrolled condition Mia s Simple Fracture in network emergency room visit and follow up care The plan s overall deductible Specialist coinsurance Hospital facility coinsurance Other coinsurance 1 000 20 20 20 The plan s overall deductible Specialist coinsurance Hospital facility coinsurance Other coinsurance 1 000 20 20 20 The plan s overall deductible Specialist coinsurance Hospital facility coinsurance Other coinsurance 1 000 20 20 20 This EXAMPLE event includes services like Specialist office visits pre natal care Childbirth Delivery Professional Services Childbirth Delivery Facility Services Diagnostic tests ultrasounds and blood work Specialist visit anesthesia This EXAMPLE event includes services like Primary care physician office visits including disease education Diagnostic tests blood work Prescription drugs Durable medical equipment glucose meter This EXAMPLE event includes services like Emergency room care including medical supplies Diagnostic tests x ray Durable medical equipment crutches Rehabilitation services physical therapy Total Example Cost 12 700 Total Example Cost 5 600 Total Example Cost 2 800 In this example Peg would pay Cost Sharing Deductibles Copayments Coinsurance What isn t covered Limits or exclusions The total Peg would pay is 1 000 10 2 000 0 3 010 In this example Joe would pay Cost Sharing Deductibles Copayments Coinsurance What isn t covered Limits or exclusions The total Joe would pay is 1 000 100 700 20 1 820 In this example Mia would pay Cost Sharing Deductibles Copayments Coinsurance What isn t covered Limits or exclusions The total Mia would pay is 1 000 500 300 0 1 800 Note These numbers assume the patient does not participate in the plan s wellness program If you participate in the plan s wellness program you may be able to reduce your costs For more information about the wellness program please contact www umr com or call 1 800 826 9781 Note This plan has other deductibles for specific services included in this coverage example See Are there other deductibles for specific services row above The plan would be responsible for the other costs of these EXAMPLE covered services Page 7 of 7

Annual Enrollment Notices Disclosures Mike Hooks LLC May 01 2024 Arthur J Gallagher Co www ajg com 2024 Arthur J Gallagher Co Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 Table of Contents Legal Notices Disclosures Page PATIENT PROTECTIONS DISCLOSURE 3 WOMEN S HEALTH CANCER RIGHTS ACT 3 NEWBORNS AND MOTHERS HEALTH PROTECTION ACT 4 PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN S HEALTH INSURANCE PROGRAM CHIP 5 HIPAA NOTICE OF PRIVACY PRACTICES REMINDER 9 HIPAA SPECIAL ENROLLMENT RIGHTS 9 NOTICE OF CREDITABLE COVERAGE 11 COBRA GENERAL NOTICE 14 MARKETPLACE NOTICE 18 SELF FUNDED NON FEDERAL GOVERNMENTAL PLAN OPT OUT NOTICE 22 If you and or your dependents have Medicare or will become eligible for Medicare in the next 12 months a Federal law gives you more choices about your prescription drug coverage Please see pages 11 13 where Notice of Creditable Coverage begin for more details 2024 Arthur J Gallagher Co 2 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 PATIENT PROTECTIONS DISCLOSURE The Mike Hooks LLC Health Plan generally allows the designation of a primary care provider You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members Until you make this designation UMR United HealthCare Choice Plus Network designates one for you For information on how to select a primary care provider and for a list of the participating primary care providers contact the UMR at 800 826 9781 and the website is www umr com For children you may designate a pediatrician as the primary care provider You do not need prior authorization from UMR United HealthCare Choice Plus Network or from any other person including a primary care provider in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology The health care professional however may be required to comply with certain procedures including obtaining prior authorization for certain services following a pre approved treatment plan or procedures for making referrals For a list of participating health care professionals who specialize in obstetrics or gynecology contact the UMR at 800 826 9781 and the website is www umr com WOMEN S HEALTH CANCER RIGHTS ACT If you have had or are going to have a mastectomy you may be entitled to certain benefits under the Women s Health and Cancer Rights Act of 1998 WHCRA For individuals receiving mastectomyrelated benefits coverage will be provided in a manner determined in consultation with the attending physician and the patient for All stages of reconstruction of the breast on which the mastectomy was performed Surgery and reconstruction of the other breast to produce a symmetrical appearance Prostheses and Treatment of physical complications of the mastectomy including lymphedema These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under the plan Therefore the following deductibles and coinsurance apply PLAN OPTION 1 PPO Plan Option UMR Individual 20 coinsurance and 1 000 deductible Family 40 coinsurance and 2 000 deductible If you would like more information on WHCRA benefits please call your Plan Administrator at 337 436 6693 or dtaylor mikehooks com 2024 Arthur J Gallagher Co 3 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 NEWBORNS AND MOTHERS HEALTH PROTECTION ACT Group health plans and health insurance issuers generally may not under Federal law restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery or less than 96 hours following a cesarean section However Federal law generally does not prohibit the mother s or newborn s attending provider after consulting with the mother from discharging the mother or her newborn earlier than 48 hours or 96 hours as applicable In any case plans and issuers may not under Federal law require that a provider obtain authorization from the plan or insurance issuer for prescribing a length of stay not in excess of 48 hours or 96 hours 2024 Arthur J Gallagher Co 4 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 PREMIUM ASSISTANCE UNDER MEDICAID AND THE CHILDREN S HEALTH INSURANCE PROGRAM CHIP If you or your children are eligible for Medicaid or CHIP and you re eligible for health coverage from your employer your state may have a premium assistance program that can help pay for coverage using funds from their Medicaid or CHIP programs If you or your children aren t eligible for Medicaid or CHIP you won t be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace For more information visit www healthcare gov If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below contact your State Medicaid or CHIP office to find out if premium assistance is available If you or your dependents are NOT currently enrolled in Medicaid or CHIP and you think you or any of your dependents might be eligible for either of these programs contact your State Medicaid or CHIP office or dial 1 877 KIDS NOW or www insurekidsnow gov to find out how to apply If you qualify ask your state if it has a program that might help you pay the premiums for an employer sponsored plan If you or your dependents are eligible for premium assistance under Medicaid or CHIP as well as eligible under your employer plan your employer must allow you to enroll in your employer plan if you aren t already enrolled This is called a special enrollment opportunity and you must request coverage within 60 days of being determined eligible for premium assistance If you have questions about enrolling in your employer plan contact the Department of Labor at www askebsa dol gov or call 1 866 444 EBSA 3272 If you live in one of the following states you may be eligible for assistance paying your employer health plan premiums The following list of states is current as of January 31 2024 Contact your State for more information on eligibility ALABAMA Medicaid Website http myalhipp com Phone 1 855 692 5447 ARKANSAS Medicaid Website http myarhipp com Phone 1 855 MyARHIPP 855 692 7447 COLORADO Health First Colorado Colorado s Medicaid Program Child Health Plan Plus CHP Health First Colorado Website https www healthfirstcolorado com Health First Colorado Member Contact Center 1 800 221 3943 State Relay 711 CHP https hcpf colorado gov child health plan plus CHP Customer Service 1 800 359 1991 State Relay 711 Health Insurance Buy In Program HIBI https www mycohibi com HIBI Customer Service 1 855 692 6442 2024 Arthur J Gallagher Co ALASKA Medicaid The AK Health Insurance Premium Payment Program Website http myakhipp com Phone 1 866 251 4861 Email CustomerService MyAKHIPP com Medicaid Eligibility https health alaska gov dpa Pages default aspx CALIFORNIA Medicaid Health Insurance Premium Payment HIPP Program Website http dhcs ca gov hipp Phone 916 445 8322 Fax 916 440 5676 Email hipp dhcs ca gov FLORIDA Medicaid Website https www flmedicaidtplrecovery com flmedicaidtplrecov ery com hipp index html Phone 1 877 357 3268 5 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 GEORGIA Medicaid GA HIPP Website https medicaid georgia gov healthinsurance premium payment program hipp Phone 678 564 1162 Press 1 GA CHIPRA Website https medicaid georgia gov programs third partyliability childrens health insurance program reauthorizationact 2009 chipra Phone 678 564 1162 Press 2 IOWA Medicaid and CHIP Hawki Medicaid Website https dhs iowa gov ime members Medicaid Phone 1 800 338 8366 Hawki Website http dhs iowa gov Hawki Hawki Phone 1 800 257 8563 HIPP Website https dhs iowa gov ime members medicaida to z hipp HIPP Phone 1 888 346 9562 KENTUCKY Medicaid Kentucky Integrated Health Insurance Premium Payment Program KI HIPP Website https chfs ky gov agencies dms member Pages kihipp aspx Phone 1 855 459 6328 Email KIHIPP PROGRAM ky gov KCHIP Website https kynect ky gov Phone 1 877 524 4718 Kentucky Medicaid Website https chfs ky gov agencies dms MAINE Medicaid Enrollment Website https www mymaineconnection gov benefits s language en _US Phone 1 800 442 6003 TTY Maine relay 711 Private Health Insurance Premium Webpage https www maine gov dhhs ofi applications forms Phone 1 800 977 6740 TTY Maine relay 711 MINNESOTA Medicaid Website https mn gov dhs people we serve children andfamilies health care health care programs programs andservices other insurance jsp Phone 1 800 657 3739 MONTANA Medicaid Website http dphhs mt gov MontanaHealthcarePrograms HIPP Phone 1 800 694 3084 Email HHSHIPPProgram mt gov INDIANA Medicaid Healthy Indiana Plan for low income adults 19 64 Website http www in gov fssa hip Phone 1 877 438 4479 All other Medicaid Website https www in gov medicaid Phone 1 800 457 4584 KANSAS Medicaid Website https www kancare ks gov Phone 1 800 792 4884 HIPP Phone 1 800 967 4660 LOUISIANA Medicaid Website www medicaid la gov or www ldh la gov lahipp Phone 1 888 342 6207 Medicaid hotline or 1 855 618 5488 LaHIPP MASSACHUSETTS Medicaid and CHIP Website https www mass gov masshealth pa Phone 1 800 862 4840 TTY 711 Email masspremassistance accenture com MISSOURI Medicaid Website http www dss mo gov mhd participants pages hipp htm Phone 573 751 2005 NEBRASKA Medicaid Website http www ACCESSNebraska ne gov Phone 1 855 632 7633 Lincoln 402 473 7000 Omaha 402 595 1178 2024 Arthur J Gallagher Co 6 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 NEVADA Medicaid Medicaid Website http dhcfp nv gov Medicaid Phone 1 800 992 0900 NEW JERSEY Medicaid and CHIP Medicaid Website http www state nj us humanservices dmahs clients medicaid Medicaid Phone 609 631 2392 CHIP Website http www njfamilycare org index html CHIP Phone 1 800 701 0710 NORTH CAROLINA Medicaid Website https medicaid ncdhhs gov Phone 919 855 4100 OKLAHOMA Medicaid and CHIP Website http www insureoklahoma org Phone 1 888 365 3742 PENNSYLVANIA Medicaid and CHIP Website https www dhs pa gov Services Assistance Pages HIPPProgram aspx Phone 1 800 692 7462 CHIP Website Children s Health Insurance Program CHIP pa gov CHIP Phone 1 800 986 KIDS 5437 SOUTH CAROLINA Medicaid Website https www scdhhs gov Phone 1 888 549 0820 NEW HAMPSHIRE Medicaid Website https www dhhs nh gov programsservices medicaid health insurance premium program Phone 603 271 5218 Toll free number for the HIPP program 1 800 852 3345 ext 5218 NEW YORK Medicaid Website https www health ny gov health_care medicaid Phone 1 800 541 2831 NORTH DAKOTA Medicaid Website https www hhs nd gov healthcare Phone 1 844 854 4825 OREGON Medicaid and CHIP Website http healthcare oregon gov Pages index aspx Phone 1 800 699 9075 RHODE ISLAND Medicaid and CHIP Website http www eohhs ri gov Phone 1 855 697 4347 or 401 462 0311 Direct RIte Share Line SOUTH DAKOTA Medicaid Website http dss sd gov Phone 1 888 828 0059 TEXAS Medicaid Website Health Insurance Premium Payment HIPP Program Texas Health and Human Services Phone 1 800 440 0493 UTAH Medicaid and CHIP Medicaid Website https medicaid utah gov CHIP Website http health utah gov chip Phone 1 877 543 7669 VERMONT Medicaid Website Health Insurance Premium Payment HIPP Program Department of Vermont Health Access Phone 1 800 250 8427 VIRGINIA Medicaid and CHIP Website https coverva dmas virginia gov learn premiumassistance famis select https coverva dmas virginia gov learn premiumassistance health insurance premium payment hipp programs Medicaid CHIP Phone 1 800 432 5924 WASHINGTON Medicaid WEST VIRGINIA Medicaid and CHIP Website https www hca wa gov Phone 1 800 562 3022 Website https dhhr wv gov bms http mywvhipp com Medicaid Phone 304 558 1700 CHIP Toll free phone 1 855 MyWVHIPP 1 855 699 8447 WISCONSIN Medicaid and CHIP Website https www dhs wisconsin gov badgercareplus p 10095 htm Phone 1 800 362 3002 WYOMING Medicaid Website https health wyo gov healthcarefin medicaid programs andeligibility Phone 1 800 251 1269 7 2024 Arthur J Gallagher Co Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 To see if any other states have added a premium assistance program since January 31 2024 or for more information on special enrollment rights contact either U S Department of Labor Employee Benefits Security Administration www dol gov agencies ebsa 1 866 444 EBSA 3272 U S Department of Health and Human Services Centers for Medicare Medicaid Services www cms hhs gov 1 877 267 2323 Menu Option 4 Ext 61565 Paperwork Reduction Act Statement According to the Paperwork Reduction Act of 1995 Pub L 104 13 PRA no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget OMB control number The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA and displays a currently valid OMB control number and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number See 44 U S C 3507 Also notwithstanding any other provisions of law no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number See 44 U S C 3512 The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to the U S Department of Labor Employee Benefits Security Administration Office of Policy and Research Attention PRA Clearance Officer 200 Constitution Avenue N W Room N 5718 Washington DC 20210 or email ebsa opr dol gov and reference the OMB Control Number 1210 0137 OMB Control Number 1210 0137 expires 1 31 2026 2024 Arthur J Gallagher Co 8 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 HIPAA NOTICE OF PRIVACY PRACTICES REMINDER Protecting Your Health Information Privacy Rights Mike Hooks LLC is committed to the privacy of your health information The administrators of the Mike Hooks LLC Health Plan the Plan use strict privacy standards to protect your health information from unauthorized use or disclosure The Plan s policies protecting your privacy rights and your rights under the law are described in the Plan s Notice of Privacy Practices You may receive a copy of the Notice of Privacy Practices by contacting Dana Talyor HR Manager at 337 436 6693 or dtaylor mikehooks com HIPAA SPECIAL ENROLLMENT RIGHTS Mike Hooks LLC Health Plan Notice of Your HIPAA Special Enrollment Rights Our records show that you are eligible to participate in the Mike Hooks LLC Health Plan to actually participate you must complete an enrollment form and pay part of the premium through payroll deduction A federal law called HIPAA requires that we notify you about an important provision in the plan your right to enroll in the plan under its special enrollment provision if you acquire a new dependent or if you decline coverage under this plan for yourself or an eligible dependent while other coverage is in effect and later lose that other coverage for certain qualifying reasons Loss of Other Coverage Excluding Medicaid or a State Children s Health Insurance Program If you decline enrollment for yourself or for an eligible dependent including your spouse while other health insurance or group health plan coverage is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage or if the employer stops contributing toward your or your dependents other coverage However you must request enrollment within 30 days after your or your dependents other coverage ends or after the employer stops contributing toward the other coverage Loss of Coverage for Medicaid or a State Children s Health Insurance Program If you decline enrollment for yourself or for an eligible dependent including your spouse while Medicaid coverage or coverage under a state children s health insurance program is in effect you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage However you must request enrollment within 60 days after your or your dependents coverage ends under Medicaid or a state children s health insurance program New Dependent by Marriage Birth Adoption or Placement for Adoption If you have a new dependent as a result of marriage birth adoption or placement for adoption you may be able to enroll yourself and your new dependents However you must request enrollment within 30 days after the marriage birth adoption or placement for adoption 2024 Arthur J Gallagher Co 9 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 Eligibility for Premium Assistance Under Medicaid or a State Children s Health Insurance Program If you or your dependents including your spouse become eligible for a state premium assistance subsidy from Medicaid or through a state children s health insurance program with respect to coverage under this plan you may be able to enroll yourself and your dependents in this plan However you must request enrollment within 60 days after your or your dependents determination of eligibility for such assistance To request special enrollment or to obtain more information about the plan s special enrollment provisions contact Dana Talyor HR Manager at 337 436 6693 or dtaylor mikehooks com Important Warning If you decline enrollment for yourself or for an eligible dependent you must complete our form to decline coverage On the form you are required to state that coverage under another group health plan or other health insurance coverage including Medicaid or a state children s health insurance program is the reason for declining enrollment and you are asked to identify that coverage If you do not complete the form you and your dependents will not be entitled to special enrollment rights upon a loss of other coverage as described above but you will still have special enrollment rights when you have a new dependent by marriage birth adoption or placement for adoption or by virtue of gaining eligibility for a state premium assistance subsidy from Medicaid or through a state children s health insurance program with respect to coverage under this plan as described above If you do not gain special enrollment rights upon a loss of other coverage you cannot enroll yourself or your dependents in the plan at any time other than the plan s annual open enrollment period unless special enrollment rights apply because of a new dependent by marriage birth adoption or placement for adoption or by virtue of gaining eligibility for a state premium assistance subsidy from Medicaid or through a state children s health insurance program with respect to coverage under this plan 2024 Arthur J Gallagher Co 10 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 NOTICE OF CREDITABLE COVERAGE Important Notice from Mike Hooks LLC About Your Prescription Drug Coverage and Medicare Please read this notice carefully and keep it where you can find it This notice has information about your current prescription drug coverage with Mike Hooks LLC and about your options under Medicare s prescription drug coverage This information can help you decide whether or not you want to join a Medicare drug plan If you are considering joining you should compare your current coverage including which drugs are covered at what cost with the coverage and costs of the plans offering Medicare prescription drug coverage in your area Information about where you can get help to make decisions about your prescription drug coverage is at the end of this notice There are two important things you need to know about your current coverage and Medicare s prescription drug coverage 1 Medicare prescription drug coverage became available in 2006 to everyone with Medicare You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan like an HMO or PPO that offers prescription drug coverage All Medicare drug plans provide at least a standard level of coverage set by Medicare Some plans may also offer more coverage for a higher monthly premium 2 Mike Hooks LLC has determined that the prescription drug coverage offered by the medical plan is on average for all plan participants expected to pay out as much as standard Medicare prescription drug coverage pays and is therefore considered Creditable Coverage Because your existing coverage is Creditable Coverage you can keep this coverage and not pay a higher premium a penalty if you later decide to join a Medicare drug plan When Can You Join a Medicare Drug Plan You can join a Medicare drug plan when you first become eligible for Medicare and each year from October 15th to December 7th However if you lose your current creditable prescription drug coverage through no fault of your own you will also be eligible for a two 2 month Special Enrollment Period SEP to join a Medicare drug plan 2024 Arthur J Gallagher Co 11 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 What Happens to Your Current Coverage if You Decide to Join a Medicare Drug Plan If you decide to join a Medicare drug plan your current Mike Hooks LLC coverage will be affected See plan SPD for more information about your prescription drug coverage provisions options If you do decide to join a Medicare drug plan and drop your current employer sponsored coverage be aware that you and your dependents will not be able to get this coverage back They can keep this coverage if they elect part D and this plan will coordinate with Part D coverage for those individuals who elect Part D coverage coverage under the entity s plan will end for the individual and all covered dependents etc See pages 7 9 of the CMS Disclosure of Creditable Coverage To Medicare Part D Eligible Individuals Guidance available at http www cms hhs gov CreditableCoverage which outlines the prescription drug plan provisions options that Medicare eligible individuals may have available to them when they become eligible for Medicare Part D If you do decide to join a Medicare drug plan and drop your current Mike Hooks LLC coverage be aware that you and your dependents may or may not be able to get this coverage back When Will You Pay a Higher Premium Penalty to Join a Medicare Drug Plan You should also know that if you drop or lose your current coverage with Mike Hooks LLC and don t join a Medicare drug plan within 63 continuous days after your current coverage ends you may pay a higher premium a penalty to join a Medicare drug plan later If you go 63 continuous days or longer without creditable prescription drug coverage your monthly premium may go up by at least 1 of the Medicare base beneficiary premium per month for every month that you did not have that coverage For example if you go nineteen months without creditable coverage your premium may consistently be at least 19 higher than the Medicare base beneficiary premium You may have to pay this higher premium a penalty as long as you have Medicare prescription drug coverage In addition you may have to wait until the following October to join For More Information About This Notice or Your Current Prescription Drug Coverage Contact the person listed below for further information NOTE You ll get this notice each year You will also get it before the next period you can join a Medicare drug plan and if this coverage through Mike Hooks LLC changes You also may request a copy of this notice at any time For More Information About Your Options Under Medicare Prescription Drug Coverage More detailed information about Medicare plans that offer prescription drug coverage is in the Medicare You handbook You ll get a copy of the handbook in the mail every year from Medicare You may also be contacted directly by Medicare drug plans 2024 Arthur J Gallagher Co 12 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 For more information about Medicare prescription drug coverage Visit www medicare gov Call your State Health Insurance Assistance Program see the inside back cover of your copy of the Medicare You handbook for their telephone number for personalized help Call 1 800 MEDICARE 1 800 633 4227 TTY users should call 1 877 486 2048 If you have limited income and resources extra help paying for Medicare prescription drug coverage is available For information about this extra help visit Social Security on the web at www socialsecurity gov or call them at 1 800 772 1213 TTY 1 800 325 0778 Remember Keep this Creditable Coverage Notice If you decide to join one of the Medicare drug plans you may be required to provide a copy of this notice when you join to show whether or not you have maintained creditable coverage and therefore whether or not you are required to pay a higher premium a penalty Date Name of Entity Sender Contact Position Office Office Address Phone Number May 01 2024 Mike Hooks LLC Dana Talyor HR Manager 409 Mike Hooks Rd Westlake Louisiana 70669 5744 United States 337 436 6693 2024 Arthur J Gallagher Co 13 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 COBRA GENERAL NOTICE Model General Notice of COBRA Continuation Coverage Rights For use by single employer group health plans Continuation Coverage Rights Under COBRA Introduction You re getting this notice because you recently gained coverage under a group health plan the Plan This notice has important information about your right to COBRA continuation coverage which is a temporary extension of coverage under the Plan This notice explains COBRA continuation coverage when it may become available to you and your family and what you need to do to protect your right to get it When you become eligible for COBRA you may also become eligible for other coverage options that may cost less than COBRA continuation coverage The right to COBRA continuation coverage was created by a federal law the Consolidated Omnibus Budget Reconciliation Act of 1985 COBRA COBRA continuation coverage can become available to you and other members of your family when group health coverage would otherwise end For more information about your rights and obligations under the Plan and under federal law you should review the Plan s Summary Plan Description or contact the Plan Administrator You may have other options available to you when you lose group health coverage For example you may be eligible to buy an individual plan through the Health Insurance Marketplace By enrolling in coverage through the Marketplace you may qualify for lower costs on your monthly premiums and lower out of pocket costs Additionally you may qualify for a 30 day special enrollment period for another group health plan for which you are eligible such as a spouse s plan even if that plan generally doesn t accept late enrollees What is COBRA continuation coverage COBRA continuation coverage is a continuation of Plan coverage when it would otherwise end because of a life event This is also called a qualifying event Specific qualifying events are listed later in this notice After a qualifying event COBRA continuation coverage must be offered to each person who is a qualified beneficiary You your spouse and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event Under the Plan qualified beneficiaries who elect COBRA continuation coverage must pay for COBRA continuation coverage If you re an employee you ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events Your hours of employment are reduced or Your employment ends for any reason other than your gross misconduct 2024 Arthur J Gallagher Co 14 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 If you re the spouse of an employee you ll become a qualified beneficiary if you lose your coverage under the Plan because of the following qualifying events Your spouse dies Your spouse s hours of employment are reduced Your spouse s employment ends for any reason other than his or her gross misconduct Your spouse becomes entitled to Medicare benefits under Part A Part B or both or You become divorced or legally separated from your spouse Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because of the following qualifying events The parent employee dies The parent employee s hours of employment are reduced The parent employee s employment ends for any reason other than his or her gross misconduct The parent employee becomes entitled to Medicare benefits Part A Part B or both The parents become divorced or legally separated or The child stops being eligible for coverage under the Plan as a dependent child Sometimes filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event If a proceeding in bankruptcy is filed with respect to Mike Hooks LLC and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan the retired employee will become a qualified beneficiary The retired employee s spouse surviving spouse and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan When is COBRA continuation coverage available The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred The employer must notify the Plan Administrator of the following qualifying events The end of employment or reduction of hours of employment Death of the employee Commencement of a proceeding in bankruptcy with respect to the employer or The employee s becoming entitled to Medicare benefits under Part A Part B or both For all other qualifying events divorce or legal separation of the employee and spouse or a dependent child s losing eligibility for coverage as a dependent child you must notify the Plan Administrator within 60 days after the qualifying event occurs You must provide this notice to Dana Talyor 2024 Arthur J Gallagher Co 15 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 How is COBRA continuation coverage provided Once the Plan Administrator receives notice that a qualifying event has occurred COBRA continuation coverage will be offered to each of the qualified beneficiaries Each qualified beneficiary will have an independent right to elect COBRA continuation coverage Covered employees may elect COBRA continuation coverage on behalf of their spouses and parents may elect COBRA continuation coverage on behalf of their children COBRA continuation coverage is a temporary continuation of coverage that generally lasts for 18 months due to employment termination or reduction of hours of work Certain qualifying events or a second qualifying event during the initial period of coverage may permit a beneficiary to receive a maximum of 36 months of coverage There are also ways in which this 18 month period of COBRA continuation coverage can be extended Disability extension of 18 month period of COBRA continuation coverage If you or anyone in your family covered under the Plan is determined by Social Security to be disabled and you notify the Plan Administrator in a timely fashion you and your entire family may be entitled to get up to an additional 11 months of COBRA continuation coverage for a maximum of 29 months The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18 month period of COBRA continuation coverage Second qualifying event extension of 18 month period of continuation coverage If your family experiences another qualifying event during the 18 months of COBRA continuation coverage the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage for a maximum of 36 months if the Plan is properly notified about the second qualifying event This extension may be available to the spouse and any dependent children getting COBRA continuation coverage if the employee or former employee dies becomes entitled to Medicare benefits under Part A Part B or both gets divorced or legally separated or if the dependent child stops being eligible under the Plan as a dependent child This extension is only available if the second qualifying event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred Are there other coverage options besides COBRA Continuation Coverage Yes Instead of enrolling in COBRA continuation coverage there may be other coverage options for you and your family through the Health Insurance Marketplace Medicare Medicaid Children s Health Insurance Program CHIP or other group health plan coverage options such as a spouse s plan through what is called a special enrollment period Some of these options may cost less than COBRA continuation coverage You can learn more about many of these options at www healthcare gov 2024 Arthur J Gallagher Co 16 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends In general if you don t enroll in Medicare Part A or B when you are first eligible because you are still employed after the Medicare initial enrollment period you have an 8 month special enrollment period1 to sign up for Medicare Part A or B beginning on the earlier of The month after your employment ends or The month after group health plan coverage based on current employment ends If you don t enroll in Medicare and elect COBRA continuation coverage instead you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends the Plan may terminate your continuation coverage However if Medicare Part A or B is effective on or before the date of the COBRA election COBRA coverage may not be discontinued on account of Medicare entitlement even if you enroll in the other part of Medicare after the date of the election of COBRA coverage If you are enrolled in both COBRA continuation coverage and Medicare Medicare will generally pay first primary payer and COBRA continuation coverage will pay second Certain plans may pay as if secondary to Medicare even if you are not enrolled in Medicare For more information visit https www medicare gov medicare and you If you have questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below For more information about your rights under the Employee Retirement Income Security Act ERISA including COBRA the Patient Protection and Affordable Care Act and other laws affecting group health plans contact the nearest Regional or District Office of the U S Department of Labor s Employee Benefits Security Administration EBSA in your area or visit www dol gov ebsa Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA s website For more information about the Marketplace visit www healthcare gov Keep your Plan informed of address changes To protect your family s rights let the Plan Administrator know about any changes in the addresses of family members You should also keep a copy for your records of any notices you send to the Plan Administrator Plan contact information Mike Hooks LLC Dana Talyor HR Manager 409 Mike Hooks Rd Westlake Louisiana 70669 5744 United States 337 436 6693 1 https www medicare gov basics get started with medicare sign up when does medicare coverage start 2024 Arthur J Gallagher Co 17 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 MARKETPLACE NOTICE Health Insurance Marketplace Coverage Options and Your Health Coverage PART A General Information Even if you are offered health coverage through your employment you may have other coverage options through the Health Insurance Marketplace Marketplace To assist you as you evaluate options for you and your family this notice provides some basic information about the Health Insurance Marketplace and health coverage offered through your employment What is the Health Insurance Marketplace The Marketplace is designed to help you find health insurance that meets your needs and fits your budget The Marketplace offers one stop shopping to find and compare private health insurance options in your geographic area Can I Save Money on my Health Insurance Premiums in the Marketplace You may qualify to save money and lower your monthly premium and other out of pocket costs but only if your employer does not offer coverage or offers coverage that is not considered affordable for you and doesn t meet certain minimum value standards discussed below The savings that you re eligible for depends on your household income You may also be eligible for a tax credit that lowers your costs Does Employment Based Health Coverage Affect Eligibility for Premium Savings through the Marketplace Yes If you have an offer of health coverage from your employer that is considered affordable for you and meets certain minimum value standards you will not be eligible for a tax credit or advance payment of the tax credit for your Marketplace coverage and may wish to enroll in your employment based health plan However you may be eligible for a tax credit and advance payments of the credit that lowers your monthly premium or a reduction in certain cost sharing if your employer does not offer coverage to you at all or does not offer coverage that is considered affordable for you or meet minimum value standards If your share of the premium cost of all plans offered to you through your employment is more than 9 12 1 of your annual household income or if the coverage through your employment does not meet the minimum value standard set by the Affordable Care Act you may be eligible for a tax credit and advance payment of the credit if you do not enroll in the employment based health coverage For family members of the employee coverage is considered affordable if the employee s cost of premiums for the lowest cost plan that would cover all family members does not exceed 9 12 of the employee s household income 1 2 Note If you purchase a health plan through the Marketplace instead of accepting health coverage offered through your employment then you may lose access to whatever the employer contributes to the employment based coverage Also this employer contribution as well as your employee contribution to employment based coverage is generally excluded from income for federal and state income tax purposes Your payments for coverage through the Marketplace are made on an after tax basis In addition note that if the health coverage offered through your employment does not meet the affordability or minimum value standards but you accept that coverage anyway you will not be eligible for a tax credit You should consider all of these factors in determining whether to purchase a health plan through the Marketplace 1 Indexed annually see https www irs gov pub irs drop rp 22 34 pdf for 2023 2 An employer sponsored or other employment based health plan meets the minimum value standard if the plan s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs For purposes of eligibility for the premium tax credit to meet the minimum value standard the health plan must also provide substantial coverage of both inpatient hospital services and physician services 18 2024 Arthur J Gallagher Co Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 When Can I Enroll in Health Insurance Coverage through the Marketplace You can enroll in a Marketplace health insurance plan during the annual Marketplace Open Enrollment Period Open Enrollment varies by state but generally starts November 1 and continues through at least December 15 Outside the annual Open Enrollment Period you can sign up for health insurance if you qualify for a Special Enrollment Period In general you qualify for a Special Enrollment Period if you ve had certain qualifying life events such as getting married having a baby adopting a child or losing eligibility for other health coverage Depending on your Special Enrollment Period type you may have 60 days before or 60 days following the qualifying life event to enroll in a Marketplace plan There is also a Marketplace Special Enrollment Period for individuals and their families who lose eligibility for Medicaid or Children s Health Insurance Program CHIP coverage on or after March 31 2023 through July 31 2024 Since the onset of the nationwide COVID 19 public health emergency state Medicaid and CHIP agencies generally have not terminated the enrollment of any Medicaid or CHIP beneficiary who was enrolled on or after March 18 2020 through March 31 2023 As state Medicaid and CHIP agencies resume regular eligibility and enrollment practices many individuals may no longer be eligible for Medicaid or CHIP coverage starting as early as March 31 2023 The U S Department of Health and Human Services is offering a temporary Marketplace Special Enrollment period to allow these individuals to enroll in Marketplace coverage Marketplace eligible individuals who live in states served by HealthCare gov and either submit a new application or update an existing application on HealthCare gov between March 31 2023 and July 31 2024 and attest to a termination date of Medicaid or CHIP coverage within the same time period are eligible for a 60 day Special Enrollment Period That means that if you lose Medicaid or CHIP coverage between March 31 2023 and July 31 2024 you may be able to enroll in Marketplace coverage within 60 days of when you lost Medicaid or CHIP coverage In addition if you or your family members are enrolled in Medicaid or CHIP coverage it is important to make sure that your contact information is up to date to make sure you get any information about changes to your eligibility To learn more visit HealthCare gov or call the Marketplace Call Center at 1 800 318 2596 TTY users can call 1 855 889 4325 What about Alternatives to Marketplace Health Insurance Coverage If you or your family are eligible for coverage in an employment based health plan such as an employer sponsored health plan you or your family may also be eligible for a Special Enrollment Period to enroll in that health plan in certain circumstances including if you or your dependents were enrolled in Medicaid or CHIP coverage and lost that coverage Generally you have 60 days after the loss of Medicaid or CHIP coverage to enroll in an employment based health plan but if you and your family lost eligibility for Medicaid or CHIP coverage between March 31 2023 and July 10 2023 you can request this special enrollment in the employment based health plan through September 8 2023 Confirm the deadline with your employer or your employment based health plan Alternatively you can enroll in Medicaid or CHIP coverage at any time by filling out an application through the Marketplace or applying directly through your state Medicaid agency Visit https www healthcare gov medicaid chip getting medicaid chip for more details How Can I Get More Information For more information about your coverage offered through your employment please check your health plan s summary plan description or contact Dana Talyor The Marketplace can help you evaluate your coverage options including your eligibility for coverage through the Marketplace and its cost Please visit HealthCare gov for more information including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area 2024 Arthur J Gallagher Co 19 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 PART B Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer If you decide to complete an application for coverage in the Marketplace you will be asked to provide this information This information is numbered to correspond to the Marketplace application 3 Employer name Mike Hooks LLC 5 Employer address 409 Mike Hooks Rd 7 City Westlake 10 Who can we contact about employee health coverage at this job Dana Talyor 11 Phone number if different from above 12 Email address dtaylor mikehooks com 4 Employer Identification Number EIN 39 1995276 6 Employer phone number 337 436 6693 8 State Louisiana 9 ZIP code 70669 5744 Here is some basic information about health coverage offered by this employer As your employer we offer a health plan to X All employees Eligible employees are All full time employees working at least 30 hours per work week Some employees Eligible employees are With respect to dependents X We do offer coverage Eligible dependents are Legal spouse eligible dependent children up to age 26 as defined by the plan contract We do not offer coverage X If checked this coverage meets the minimum value standard and the cost of this coverage to you is intended to be affordable based on employee wages Even if your employer intends your coverage to be affordable you may still be eligible for a premium discount through the Marketplace The Marketplace will use your household income along with other factors to determine whether you may be eligible for a premium discount If for example your wages vary from week to week perhaps you are an hourly employee or you work on a commission basis if you are newly employed midyear or if you have other income losses you may still qualify for a premium discount If you decide to shop for coverage in the Marketplace HealthCare gov will guide you through the process Here s the employer information you ll enter when you visit HealthCare gov to find out if you can get a tax credit to lower your monthly premiums The information below corresponds to the Marketplace Employer Coverage Tool Completing this section is optional for employers but will help ensure employees understand their coverage choices 2024 Arthur J Gallagher Co 20 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 13 Is the employee currently eligible for coverage offered by this employer or will the employee be eligible in the next 3 months Yes Continue 13a If the employee is not eligible today including as a result of a waiting or probationary period when is the employee eligible for coverage mm dd yyyy Continue No STOP and return this form to employee ________________________________________________________________________________ 14 Does the employer offer a health plan that meets the minimum value standard Yes Go to question 15 No STOP and return form to employee ________________________________________________________________________________ 15 For the lowest cost plan that meets the minimum value standard offered only to the employee don t include family plans If the employer has wellness programs provide the premium that the employee would pay if he she received the maximum discount for any tobacco cessation programs and didn t receive any other discounts based on wellness programs a How much would the employee have to pay in premiums for this plan b How often Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly ________________________________________________________________________________ If the plan year will end soon and you know that the health plans offered will change go to question 16 If you don t know STOP and return form to employee ________________________________________________________________________________ 16 What change will the employer make for the new plan year Employer won t offer health coverage Employer will start offering health coverage to employees or change the premium for the lowest cost plan available only to the employee that meets the minimum value standard Premium should reflect the discount for wellness programs See question 15 a How much would the employee have to pay in premiums for this plan ____________ b How often Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly An employer sponsored health plan meets the minimum value standard if the plan s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs Section 36B c 2 C ii of the Internal Revenue Code of 1986 21 2024 Arthur J Gallagher Co Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 SELF FUNDED NON FEDERAL GOVERNMENTAL PLAN OPT OUT NOTICE Model Notice to Enrollees in a Self Funded Nonfederal Governmental Group Health Plan For Plan Years Beginning On or After September 23 2010 This notice is appropriate in the case of a collectively bargained plan ratified on or after March 23 2010 Group health plans sponsored by State and local governmental employers must generally comply with Federal law requirements in title XXVII of the Public Health Service Act However these employers are permitted to elect to exempt a plan from the requirements listed below for any part of the plan that is self funded by the employer rather than provided through a health insurance policy Mike Hooks LLC has elected to exempt Mike Hooks LLC Health Plan from some of the following requirements 1 Protection against limiting hospital stays in connection with the birth of a child to less than 48 hours for a vaginal delivery and 96 hours for a cesarean section 2 Protections against having benefits for mental health and substance use disorders be subject to more restrictions than apply to medical and surgical benefits covered by the plan 3 Certain requirements to provide benefits for breast reconstruction after a mastectomy 4 Continued coverage for up to one year for a dependent child who is covered as a dependent under the plan solely based on student status who takes a medically necessary leave of absence from a postsecondary educational institution The exemption from these Federal requirements will be in effect for the beginning 5 1 2024 and ending 4 30 2025 The election may be renewed for subsequent plan years PRA Disclosure Statement According to the Paperwork Reduction Act of 1995 no persons are required to respond to a collection of information unless it displays a valid OMB control number The valid OMB control number for this information collection is 0938 0702 The time required to complete this information collection is estimated to average 15 minutes per response including the time to review instructions search existing data resources gather the data needed and complete and review the information collection If you have comments concerning the accuracy of the time estimate s or suggestions for improving this form please write to CMS 7500 Security Boulevard Attn PRA Reports Clearance Officer Mail Stop C4 26 05 Baltimore Maryland 21244 1850 2024 Arthur J Gallagher Co 22 Rev 1 4 24

ANNUAL ENROLLMENT MAY 2024 Disclaimer The amount the plan pays for covered services provided by non network providers is based on a maximum allowable amount for the specific service rendered Although your plan stipulates an outof pocket maximum for out of network services please note the maximum allowed amount for an eligible procedure may not be equal to the amount charged by your out of network provider Your outof network provider may bill you for the difference between the amount charged and the maximum allowed amount This is called balance billing and the amount billed to you can be substantial The out of pocket maximum outlined in your policy will not include amounts in excess of the allowable charge and other non covered expenses as defined by your plan The maximum reimbursable amount for non network providers can be based on a number of schedules such as a percentage of reasonable and customary or a percentage of Medicare The plan document or carrier s master policy is the controlling document and this Benefit Highlight does not include all of the terms coverage exclusions limitations and conditions of the actual plan language Contact your claims payer or insurer for more information This document is an outline of the coverage proposed by the carrier s based on information provided by your company It does not include all of the terms coverage exclusions limitations and conditions of the actual contract language The policies and contracts themselves must be read for those details Policy forms for your reference will be made available upon request The intent of this document is to provide you with general information regarding the status of and or potential concerns related to your current employee benefits environment It does not necessarily fully address all of your specific issues It should not be construed as nor is it intended to provide legal advice Questions regarding specific issues should be addressed by your general counsel or an attorney who specializes in this practice area 2024 Arthur J Gallagher Co 23 Rev 1 4 24