401k Plan data: ADAIR HOMES EMPLOYEE BENEFIT PLAN plan

ADAIR HOMES EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	ADAIR HOMES EMPLOYEE BENEFIT PLAN
Plan identification number	501

ADAIR HOMES EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

ADAIR HOMES, INC. has sponsored the creation of one or more 401k plans.

Company Name: ADAIR HOMES, INC.

Employer identification number (EIN): 910868125

NAIC Classification: 236110

Additional information about ADAIR HOMES, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 1971-01-27

Company Identification Number: 9197914

Legal Registered Office Address: 780 COMMERCIAL ST SE STE 100

SALEM
United States of America (USA)
97301

More information about ADAIR HOMES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ADAIR HOMES EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01
501 2012-01-01 MISTY BENDER
501 2011-01-01 MARK HOUGH
501 2010-01-01 MARK HOUGH
501 2009-01-01 MARK HOUGH

Plan Statistics for ADAIR HOMES EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for ADAIR HOMES EMPLOYEE BENEFIT PLAN

Measure Date Value
2019: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 140
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 139
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 139
Total participants 2019-01-01 139
Number of employers contributing to the scheme 2019-01-01 0
2012: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 168
Number of retired or separated participants receiving benefits 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 1
Total of all active and inactive participants 2012-01-01 171
Total participants 2012-01-01 171
2011: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 108
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 105
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 105
2010: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 106
Number of retired or separated participants receiving benefits 2010-01-01 2
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 108
2009: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 106
Number of retired or separated participants receiving benefits 2009-01-01 13
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 119

Measure	Date	Value
2019: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	140
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	139
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	139
Total participants	2019-01-01	139
Number of employers contributing to the scheme	2019-01-01	0
2012: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	168
Number of retired or separated participants receiving benefits	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	1
Total of all active and inactive participants	2012-01-01	171
Total participants	2012-01-01	171
2011: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	108
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	105
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	105
2010: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	106
Number of retired or separated participants receiving benefits	2010-01-01	2
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	108
2009: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	106
Number of retired or separated participants receiving benefits	2009-01-01	13
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	119

Form 5500 Responses for ADAIR HOMES EMPLOYEE BENEFIT PLAN

2019: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2012: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: ADAIR HOMES EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

Policy instance

Number of Individuals Covered	136
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,737
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,737
Insurance broker organization code?	3

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Company Name:	ADAIR HOMES, INC.
Employer identification number (EIN):	910868125
NAIC Classification:	236110

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	1971-01-27
Company Identification Number:	9197914
Legal Registered Office Address:	780 COMMERCIAL ST SE STE 100 SALEM United States of America (USA) 97301

Plan id#	Filing Submission Date	Name of Administrator
501	2019-01-01
501	2012-01-01	MISTY BENDER
501	2011-01-01	MARK HOUGH
501	2010-01-01	MARK HOUGH
501	2009-01-01	MARK HOUGH