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OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 401k Plan overview

Plan NameOREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN
Plan identification number 501

OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION has sponsored the creation of one or more 401k plans.

Company Name:OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION
Employer identification number (EIN):237083114
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Additional information about OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 1970-09-28
Company Identification Number: 9089517
Legal Registered Office Address: 1121 SW SALMON ST STE 100

PORTLAND
United States of America (USA)
97205

More information about OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01
5012021-07-01
5012020-07-01
5012019-07-01
5012018-07-01
5012017-07-01TARA SIMS TARA SIMS2018-12-27
5012016-07-01EMILY CULLIGAN EMILY CULLIGAN2017-11-16
5012015-07-01JOY MCCAMMON JOY MCCAMMON2016-10-21
5012014-07-01JOY MCCAMMON JOY MCCAMMON2016-01-19
5012013-07-01JOY MCCAMMON JOY MCCAMMON2015-01-12
5012012-07-01JOY MCCAMMON JOY MCCAMMON2013-12-19
5012011-07-01JOY MCCAMMON JOY MCCAMMON2013-03-14

Plan Statistics for OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN

401k plan membership statisitcs for OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN

Measure Date Value
2022: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01110
Total number of active participants reported on line 7a of the Form 55002022-07-01115
Number of retired or separated participants receiving benefits2022-07-011
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01116
2021: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01100
Total number of active participants reported on line 7a of the Form 55002021-07-01103
Number of retired or separated participants receiving benefits2021-07-012
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01105
2020: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01104
Total number of active participants reported on line 7a of the Form 55002020-07-01100
Number of retired or separated participants receiving benefits2020-07-011
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01101
2019: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01106
Total number of active participants reported on line 7a of the Form 55002019-07-01104
Number of retired or separated participants receiving benefits2019-07-011
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01105
2018: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01106
Total number of active participants reported on line 7a of the Form 55002018-07-01104
Number of retired or separated participants receiving benefits2018-07-011
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01105
2017: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01105
Total number of active participants reported on line 7a of the Form 55002017-07-01108
Number of retired or separated participants receiving benefits2017-07-011
Number of other retired or separated participants entitled to future benefits2017-07-014
Total of all active and inactive participants2017-07-01113
2016: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01113
Total number of active participants reported on line 7a of the Form 55002016-07-01111
Number of retired or separated participants receiving benefits2016-07-012
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01113
2015: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01115
Total number of active participants reported on line 7a of the Form 55002015-07-01113
Number of retired or separated participants receiving benefits2015-07-011
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01114
2014: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01115
Total number of active participants reported on line 7a of the Form 55002014-07-01111
Number of retired or separated participants receiving benefits2014-07-011
Number of other retired or separated participants entitled to future benefits2014-07-011
Total of all active and inactive participants2014-07-01113
2013: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01117
Total number of active participants reported on line 7a of the Form 55002013-07-01108
Total of all active and inactive participants2013-07-01108
2012: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01115
Total number of active participants reported on line 7a of the Form 55002012-07-01117
Total of all active and inactive participants2012-07-01117
2011: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01109
Total number of active participants reported on line 7a of the Form 55002011-07-01115
Total of all active and inactive participants2011-07-01115

Form 5500 Responses for OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN

2022: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2021: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01First time form 5500 has been submittedYes
2011-07-01Plan funding arrangement – General assets of the sponsorYes
2011-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract number
Policy instance 8
Number of Individuals Covered110
Insurance policy start date2022-07-01
Insurance policy end date2022-12-31
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $1,089
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 1
Insurance contract or identification number606400
Number of Individuals Covered112
Insurance policy start date2022-07-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,861
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,861
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 2
Insurance contract or identification number606400
Number of Individuals Covered112
Insurance policy start date2022-07-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,302
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,302
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 3
Insurance contract or identification number606400
Number of Individuals Covered112
Insurance policy start date2022-07-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,518
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,518
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number7111
Policy instance 4
Insurance contract or identification number7111
Number of Individuals Covered32
Insurance policy start date2022-07-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,880
Total amount of fees paid to insurance companyUSD $104
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $154,498
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,880
Amount paid for insurance broker fees104
Additional information about fees paid to insurance brokerNON-MONETARY COMP/BONUS
Insurance broker organization code?3
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10010287
Policy instance 5
Insurance contract or identification number10010287
Number of Individuals Covered166
Insurance policy start date2022-07-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $35,909
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $866,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,909
Insurance broker organization code?3
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10010287
Policy instance 6
Insurance contract or identification number10010287
Number of Individuals Covered166
Insurance policy start date2022-07-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,082
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,082
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberJ4J68
Policy instance 7
Insurance contract or identification numberJ4J68
Number of Individuals Covered9
Insurance policy start date2022-07-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $663
Other welfare benefits providedSUPPLEMENTAL HEALTH/LIFE/DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $3,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $400
Additional information about fees paid to insurance brokerADMIN
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 1
Insurance contract or identification number606400
Number of Individuals Covered103
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $2,228
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,228
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 2
Insurance contract or identification number606400
Number of Individuals Covered103
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $4,475
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,475
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 3
Insurance contract or identification number606400
Number of Individuals Covered103
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $2,724
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,724
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number7111
Policy instance 4
Insurance contract or identification number7111
Number of Individuals Covered26
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $6,652
Total amount of fees paid to insurance companyUSD $102
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $222,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,652
Amount paid for insurance broker fees102
Additional information about fees paid to insurance brokerNON-MONETARY COMP/BONUS
Insurance broker organization code?3
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10010287
Policy instance 5
Insurance contract or identification number10010287
Number of Individuals Covered163
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $84,565
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,691,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $84,565
Insurance broker organization code?3
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10010287
Policy instance 6
Insurance contract or identification number10010287
Number of Individuals Covered163
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $4,994
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $99,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,994
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberJ4J68
Policy instance 7
Insurance contract or identification numberJ4J68
Number of Individuals Covered9
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $734
Other welfare benefits providedSUPPLEMENTAL HEALTH/LIFE/DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $8,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $387
Additional information about fees paid to insurance brokerADMIN
Insurance broker organization code?3
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract number
Policy instance 8
Number of Individuals Covered110
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $1,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 1
Insurance contract or identification number606400
Number of Individuals Covered100
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $2,221
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,221
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 2
Insurance contract or identification number606400
Number of Individuals Covered100
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $4,446
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,446
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 3
Insurance contract or identification number606400
Number of Individuals Covered100
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $2,706
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,706
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number7111
Policy instance 4
Insurance contract or identification number7111
Number of Individuals Covered27
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $6,927
Total amount of fees paid to insurance companyUSD $140
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $234,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,927
Amount paid for insurance broker fees140
Additional information about fees paid to insurance brokerNON-MONETARY COMP/BONUS
Insurance broker organization code?3
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10010287
Policy instance 5
Insurance contract or identification number10010287
Number of Individuals Covered170
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $82,804
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,650,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $82,804
Insurance broker organization code?3
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10010287
Policy instance 6
Insurance contract or identification number10010287
Number of Individuals Covered170
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $5,084
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $101,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,084
Insurance broker organization code?3
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberJ4J68
Policy instance 7
Insurance contract or identification numberJ4J68
Number of Individuals Covered11
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $1,196
Total amount of fees paid to insurance companyUSD $73
Other welfare benefits providedSUPPLEMENTAL HEALTH/LIFE/DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $13,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $740
Amount paid for insurance broker fees61
Additional information about fees paid to insurance brokerADMIN
Insurance broker organization code?3
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract number
Policy instance 8
Number of Individuals Covered83
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $1,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberJ4J68
Policy instance 7
Insurance contract or identification numberJ4J68
Number of Individuals Covered13
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $2,912
Total amount of fees paid to insurance companyUSD $231
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,254
Amount paid for insurance broker fees133
Additional information about fees paid to insurance brokerADMIN
Insurance broker organization code?3
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10010287
Policy instance 6
Insurance contract or identification number10010287
Number of Individuals Covered178
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $4,905
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,905
Insurance broker organization code?3
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10010287
Policy instance 5
Insurance contract or identification number10010287
Number of Individuals Covered178
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $77,990
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,565,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $77,990
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 1
Insurance contract or identification number606400
Number of Individuals Covered105
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $3,247
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,247
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 2
Insurance contract or identification number606400
Number of Individuals Covered105
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $6,118
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,118
Insurance broker organization code?3
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 )
Policy contract number
Policy instance 8
Number of Individuals Covered83
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Other welfare benefits providedEAP
Welfare Benefit Premiums Paid to CarrierUSD $1,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number7111
Policy instance 4
Insurance contract or identification number7111
Number of Individuals Covered24
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $5,987
Total amount of fees paid to insurance companyUSD $269
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $198,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,987
Amount paid for insurance broker fees269
Additional information about fees paid to insurance brokerNON-MONETARY COMP/BONUS
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 3
Insurance contract or identification number606400
Number of Individuals Covered105
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $3,631
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,631
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 1
Insurance contract or identification number606400
Number of Individuals Covered100
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $3,127
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,672
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 3
Insurance contract or identification number606400
Number of Individuals Covered100
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $3,486
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,065
Insurance broker organization code?3
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10010287
Policy instance 5
Insurance contract or identification number10010287
Number of Individuals Covered159
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $68,354
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,367,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,354
Insurance broker organization code?3
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10010287
Policy instance 6
Insurance contract or identification number10010287
Number of Individuals Covered159
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $4,679
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $93,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,679
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 2
Insurance contract or identification number606400
Number of Individuals Covered100
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $6,011
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,326
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number7111
Policy instance 4
Insurance contract or identification number7111
Number of Individuals Covered28
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $5,718
Total amount of fees paid to insurance companyUSD $2
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $206,630
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,718
Amount paid for insurance broker fees2
Additional information about fees paid to insurance brokerNON-MONETARY COMP
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 1
Insurance contract or identification number606400
Number of Individuals Covered103
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $2,742
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,742
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 2
Insurance contract or identification number606400
Number of Individuals Covered103
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $5,507
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,507
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING, LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 3
Insurance contract or identification number606400
Number of Individuals Covered103
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $3,099
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,099
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING, LLC
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number7111
Policy instance 4
Insurance contract or identification number7111
Number of Individuals Covered29
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $7,347
Total amount of fees paid to insurance companyUSD $162
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $224,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,347
Amount paid for insurance broker fees162
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10010287
Policy instance 5
Insurance contract or identification number10010287
Number of Individuals Covered167
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $61,407
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,237,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,407
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10010287
Policy instance 6
Insurance contract or identification number10010287
Number of Individuals Covered167
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $4,103
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,103
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 1
Insurance contract or identification number606400
Number of Individuals Covered113
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $2,706
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,706
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 3
Insurance contract or identification number606400
Number of Individuals Covered112
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $3,608
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,608
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING, LLC
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number7111
Policy instance 4
Insurance contract or identification number7111
Number of Individuals Covered33
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $6,581
Total amount of fees paid to insurance companyUSD $81
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $219,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,581
Amount paid for insurance broker fees81
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10010287
Policy instance 5
Insurance contract or identification number10010287
Number of Individuals Covered177
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $76,745
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,340,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $76,745
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10010287
Policy instance 6
Insurance contract or identification number10010287
Number of Individuals Covered177
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $5,269
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $92,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,269
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 2
Insurance contract or identification number606400
Number of Individuals Covered113
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $5,148
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,148
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING, LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 1
Insurance contract or identification number606400
Number of Individuals Covered113
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $2,285
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,285
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 2
Insurance contract or identification number606400
Number of Individuals Covered113
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $4,616
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,616
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING, LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 3
Insurance contract or identification number606400
Number of Individuals Covered113
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $2,419
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,419
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING, LLC
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number7111
Policy instance 4
Insurance contract or identification number7111
Number of Individuals Covered32
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $7,454
Total amount of fees paid to insurance companyUSD $169
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $248,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,454
Amount paid for insurance broker fees169
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10010287
Policy instance 5
Insurance contract or identification number10010287
Number of Individuals Covered175
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $59,947
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,947
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10010287
Policy instance 6
Insurance contract or identification number10010287
Number of Individuals Covered175
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $4,224
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,224
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 3
Insurance contract or identification number606400
Number of Individuals Covered108
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $2,418
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,418
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING, LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 2
Insurance contract or identification number606400
Number of Individuals Covered108
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $4,616
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,616
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING, LLC
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number7111
Policy instance 4
Insurance contract or identification number7111
Number of Individuals Covered33
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $6,330
Total amount of fees paid to insurance companyUSD $134
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $257,290
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,330
Amount paid for insurance broker fees134
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10010287
Policy instance 5
Insurance contract or identification number10010287
Number of Individuals Covered90
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $61,031
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,031
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10010287
Policy instance 6
Insurance contract or identification number10010287
Number of Individuals Covered90
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $4,452
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,452
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 1
Insurance contract or identification number606400
Number of Individuals Covered108
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $2,283
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,283
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number
Policy instance 4
Number of Individuals Covered97
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $69,078
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,381,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,881
Insurance broker organization code?3
Insurance broker nameROSENBAUM FINANCIAL LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 3
Insurance contract or identification number606400
Number of Individuals Covered117
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $2,385
Temporary Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $907
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING, LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 2
Insurance contract or identification number606400
Number of Individuals Covered117
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $4,605
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,119
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING, LLC
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number7111
Policy instance 5
Insurance contract or identification number7111
Number of Individuals Covered32
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $5,576
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $238,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,066
Insurance broker organization code?3
Insurance broker nameROSENBAUM FINANCIAL LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 1
Insurance contract or identification number606400
Number of Individuals Covered117
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $2,266
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $929
Insurance broker organization code?3
Insurance broker nameDAVIDSON BENEFITS PLANNING LLC
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number
Policy instance 4
Number of Individuals Covered91
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $60,425
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,208,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 2
Insurance contract or identification number606400
Number of Individuals Covered115
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $4,559
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $55,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 3
Insurance contract or identification number606400
Number of Individuals Covered115
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,283
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number7111
Policy instance 5
Insurance contract or identification number7111
Number of Individuals Covered115
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $5,949
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $242,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number606400
Policy instance 1
Insurance contract or identification number606400
Number of Individuals Covered115
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,167
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $42,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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