PACIFIC UNIVERSITY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN
Measure | Date | Value |
---|
2022: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2022 401k membership |
---|
Total participants, beginning-of-year | 2022-01-01 | 681 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 667 |
Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
Total of all active and inactive participants | 2022-01-01 | 667 |
Number of employers contributing to the scheme | 2022-01-01 | 0 |
2021: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2021 401k membership |
---|
Total participants, beginning-of-year | 2021-01-01 | 661 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 675 |
Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
Total of all active and inactive participants | 2021-01-01 | 675 |
Number of employers contributing to the scheme | 2021-01-01 | 0 |
2020: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2020 401k membership |
---|
Total participants, beginning-of-year | 2020-04-01 | 606 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 600 |
Number of retired or separated participants receiving benefits | 2020-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 0 |
Total of all active and inactive participants | 2020-04-01 | 600 |
Number of employers contributing to the scheme | 2020-04-01 | 0 |
2019: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2019 401k membership |
---|
Total participants, beginning-of-year | 2019-04-01 | 958 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 954 |
Number of retired or separated participants receiving benefits | 2019-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
Total of all active and inactive participants | 2019-04-01 | 954 |
2018: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2018 401k membership |
---|
Total participants, beginning-of-year | 2018-04-01 | 1,286 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 958 |
Number of retired or separated participants receiving benefits | 2018-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-04-01 | 0 |
Total of all active and inactive participants | 2018-04-01 | 958 |
2017: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2017 401k membership |
---|
Total participants, beginning-of-year | 2017-04-01 | 781 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 788 |
Number of retired or separated participants receiving benefits | 2017-04-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 0 |
Total of all active and inactive participants | 2017-04-01 | 791 |
2016: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2016 401k membership |
---|
Total participants, beginning-of-year | 2016-04-01 | 735 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 781 |
Number of retired or separated participants receiving benefits | 2016-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-04-01 | 0 |
Total of all active and inactive participants | 2016-04-01 | 781 |
2015: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2015 401k membership |
---|
Total participants, beginning-of-year | 2015-04-01 | 696 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 735 |
Number of retired or separated participants receiving benefits | 2015-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-04-01 | 0 |
Total of all active and inactive participants | 2015-04-01 | 735 |
2014: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2014 401k membership |
---|
Total participants, beginning-of-year | 2014-04-01 | 715 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 696 |
Number of retired or separated participants receiving benefits | 2014-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-04-01 | 0 |
Total of all active and inactive participants | 2014-04-01 | 696 |
2013: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2013 401k membership |
---|
Total participants, beginning-of-year | 2013-04-01 | 678 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 715 |
Number of retired or separated participants receiving benefits | 2013-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-04-01 | 0 |
Total of all active and inactive participants | 2013-04-01 | 715 |
2012: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2012 401k membership |
---|
Total participants, beginning-of-year | 2012-04-01 | 643 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 678 |
Number of retired or separated participants receiving benefits | 2012-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-04-01 | 0 |
Total of all active and inactive participants | 2012-04-01 | 678 |
2011: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2011 401k membership |
---|
Total participants, beginning-of-year | 2011-04-01 | 631 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 643 |
Number of retired or separated participants receiving benefits | 2011-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-04-01 | 0 |
Total of all active and inactive participants | 2011-04-01 | 643 |
2010: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2010 401k membership |
---|
Total participants, beginning-of-year | 2010-04-01 | 629 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-04-01 | 631 |
Number of retired or separated participants receiving benefits | 2010-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2010-04-01 | 0 |
Total of all active and inactive participants | 2010-04-01 | 631 |
2009: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2009 401k membership |
---|
Total participants, beginning-of-year | 2009-04-01 | 620 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 622 |
Number of retired or separated participants receiving benefits | 2009-04-01 | 7 |
Number of other retired or separated participants entitled to future benefits | 2009-04-01 | 0 |
Total of all active and inactive participants | 2009-04-01 | 629 |
2022: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2022 form 5500 responses |
---|
2022-01-01 | Type of plan entity | Single employer plan |
2022-01-01 | Plan funding arrangement – Insurance | Yes |
2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-01-01 | Plan benefit arrangement – Insurance | Yes |
2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2021 form 5500 responses |
---|
2021-01-01 | Type of plan entity | Single employer plan |
2021-01-01 | Plan funding arrangement – Insurance | Yes |
2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-01-01 | Plan benefit arrangement – Insurance | Yes |
2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2020 form 5500 responses |
---|
2020-04-01 | Type of plan entity | Single employer plan |
2020-04-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2020-04-01 | Plan funding arrangement – Insurance | Yes |
2020-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-04-01 | Plan benefit arrangement – Insurance | Yes |
2020-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2019 form 5500 responses |
---|
2019-04-01 | Type of plan entity | Single employer plan |
2019-04-01 | Submission has been amended | No |
2019-04-01 | This submission is the final filing | No |
2019-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-04-01 | Plan is a collectively bargained plan | No |
2019-04-01 | Plan funding arrangement – Insurance | Yes |
2019-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-04-01 | Plan benefit arrangement – Insurance | Yes |
2019-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2018 form 5500 responses |
---|
2018-04-01 | Type of plan entity | Single employer plan |
2018-04-01 | Submission has been amended | No |
2018-04-01 | This submission is the final filing | No |
2018-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-04-01 | Plan is a collectively bargained plan | No |
2018-04-01 | Plan funding arrangement – Insurance | Yes |
2018-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-04-01 | Plan benefit arrangement – Insurance | Yes |
2018-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2017 form 5500 responses |
---|
2017-04-01 | Type of plan entity | Single employer plan |
2017-04-01 | Plan funding arrangement – Insurance | Yes |
2017-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-04-01 | Plan benefit arrangement – Insurance | Yes |
2017-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2016 form 5500 responses |
---|
2016-04-01 | Type of plan entity | Single employer plan |
2016-04-01 | Submission has been amended | No |
2016-04-01 | This submission is the final filing | No |
2016-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-04-01 | Plan is a collectively bargained plan | No |
2016-04-01 | Plan funding arrangement – Insurance | Yes |
2016-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-04-01 | Plan benefit arrangement – Insurance | Yes |
2016-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2015 form 5500 responses |
---|
2015-04-01 | Type of plan entity | Single employer plan |
2015-04-01 | Submission has been amended | No |
2015-04-01 | This submission is the final filing | No |
2015-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-04-01 | Plan is a collectively bargained plan | No |
2015-04-01 | Plan funding arrangement – Insurance | Yes |
2015-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-04-01 | Plan benefit arrangement – Insurance | Yes |
2015-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2014 form 5500 responses |
---|
2014-04-01 | Type of plan entity | Single employer plan |
2014-04-01 | Submission has been amended | No |
2014-04-01 | This submission is the final filing | No |
2014-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-04-01 | Plan is a collectively bargained plan | No |
2014-04-01 | Plan funding arrangement – Insurance | Yes |
2014-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-04-01 | Plan benefit arrangement – Insurance | Yes |
2014-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2013 form 5500 responses |
---|
2013-04-01 | Type of plan entity | Single employer plan |
2013-04-01 | Submission has been amended | No |
2013-04-01 | This submission is the final filing | No |
2013-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-04-01 | Plan is a collectively bargained plan | No |
2013-04-01 | Plan funding arrangement – Insurance | Yes |
2013-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-04-01 | Plan benefit arrangement – Insurance | Yes |
2013-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2012 form 5500 responses |
---|
2012-04-01 | Type of plan entity | Single employer plan |
2012-04-01 | Submission has been amended | No |
2012-04-01 | This submission is the final filing | No |
2012-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-04-01 | Plan is a collectively bargained plan | No |
2012-04-01 | Plan funding arrangement – Insurance | Yes |
2012-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-04-01 | Plan benefit arrangement – Insurance | Yes |
2012-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2011 form 5500 responses |
---|
2011-04-01 | Type of plan entity | Single employer plan |
2011-04-01 | Submission has been amended | No |
2011-04-01 | This submission is the final filing | No |
2011-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-04-01 | Plan is a collectively bargained plan | No |
2011-04-01 | Plan funding arrangement – Insurance | Yes |
2011-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-04-01 | Plan benefit arrangement – Insurance | Yes |
2011-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2010: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2010 form 5500 responses |
---|
2010-04-01 | Type of plan entity | Single employer plan |
2010-04-01 | Submission has been amended | No |
2010-04-01 | This submission is the final filing | No |
2010-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-04-01 | Plan is a collectively bargained plan | No |
2010-04-01 | Plan funding arrangement – Insurance | Yes |
2010-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2010-04-01 | Plan benefit arrangement – Insurance | Yes |
2010-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: PACIFIC UNIVERSITY EMPLOYEE BENEFITS PLAN 2009 form 5500 responses |
---|
2009-04-01 | Type of plan entity | Single employer plan |
2009-04-01 | Submission has been amended | No |
2009-04-01 | This submission is the final filing | No |
2009-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-04-01 | Plan is a collectively bargained plan | No |
2009-04-01 | Plan funding arrangement – Insurance | Yes |
2009-04-01 | Plan benefit arrangement – Insurance | Yes |
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | GRP00005061 |
Policy instance | 2 |
Insurance contract or identification number | GRP00005061 | Number of Individuals Covered | 270 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $349,359 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 ) |
Policy contract number | OR406 |
Policy instance | 6 |
Insurance contract or identification number | OR406 | Number of Individuals Covered | 386 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
Policy contract number | 10042154 |
Policy instance | 5 |
Insurance contract or identification number | 10042154 | Number of Individuals Covered | 614 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,807,611 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 4 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 483 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $132,170 | 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 number | 1682 |
Policy instance | 3 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 711 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,124,923 | 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 number | 163529 |
Policy instance | 7 |
Insurance contract or identification number | 163529 | Number of Individuals Covered | 981 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $18,232 | Total amount of fees paid to insurance company | USD $5,364 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,232 | Amount paid for insurance broker fees | 5364 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | PACU EAP |
Policy instance | 1 |
Insurance contract or identification number | PACU EAP | Number of Individuals Covered | 787 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $20,733 | 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 number | 163529 |
Policy instance | 7 |
Insurance contract or identification number | 163529 | Number of Individuals Covered | 990 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $21,306 | Total amount of fees paid to insurance company | USD $4,394 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,306 | Amount paid for insurance broker fees | 4394 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
|
WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 ) |
Policy contract number | OR406 |
Policy instance | 6 |
Insurance contract or identification number | OR406 | Number of Individuals Covered | 395 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | 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 number | 1682 |
Policy instance | 3 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 735 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,860,594 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | PACU EAP |
Policy instance | 1 |
Insurance contract or identification number | PACU EAP | Number of Individuals Covered | 638 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $16,614 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | GRP00005061 |
Policy instance | 2 |
Insurance contract or identification number | GRP00005061 | Number of Individuals Covered | 289 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $370,774 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 4 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 482 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $92,856 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
Policy contract number | 10042154 |
Policy instance | 5 |
Insurance contract or identification number | 10042154 | Number of Individuals Covered | 620 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,429,525 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | GRP00005061 |
Policy instance | 2 |
Insurance contract or identification number | GRP00005061 | Number of Individuals Covered | 285 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $280,492 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | PACU EAP |
Policy instance | 1 |
Insurance contract or identification number | PACU EAP | Number of Individuals Covered | 638 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $12,237 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
Policy contract number | 10042154 |
Policy instance | 5 |
Insurance contract or identification number | 10042154 | Number of Individuals Covered | 581 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,856,788 | 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 number | 1682 |
Policy instance | 3 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 777 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,133,423 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 4 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 479 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $68,177 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 ) |
Policy contract number | OR406 |
Policy instance | 6 |
Insurance contract or identification number | OR406 | Number of Individuals Covered | 407 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | 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 number | 163529 |
Policy instance | 7 |
Insurance contract or identification number | 163529 | Number of Individuals Covered | 991 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $5,472 | Total amount of fees paid to insurance company | USD $4,267 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,472 | Amount paid for insurance broker fees | 4267 | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 5 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 473 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | 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 | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $89,285 | 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 number | 163529 |
Policy instance | 7 |
Insurance contract or identification number | 163529 | Number of Individuals Covered | 954 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $5,712 | Total amount of fees paid to insurance company | USD $0 | 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 | No | 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 $5,712 | Insurance broker organization code? | 3 |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | GRP00005061 |
Policy instance | 3 |
Insurance contract or identification number | GRP00005061 | Number of Individuals Covered | 283 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | 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 | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $359,426 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
Policy contract number | 1682 |
Policy instance | 2 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 803 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $12,056 | Total amount of fees paid to insurance company | USD $3,000 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $2,827,479 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,056 | Amount paid for insurance broker fees | 3000 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | 4067 |
Policy instance | 1 |
Insurance contract or identification number | 4067 | Number of Individuals Covered | 638 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $13,934 | 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 number | 163529 |
Policy instance | 8 |
Insurance contract or identification number | 163529 | Number of Individuals Covered | 774 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $5,522 | Total amount of fees paid to insurance company | USD $0 | 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 | No | 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 $5,522 | Insurance broker organization code? | 3 |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 163529 |
Policy instance | 9 |
Insurance contract or identification number | 163529 | Number of Individuals Covered | 774 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $5,930 | Total amount of fees paid to insurance company | USD $0 | 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | 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 $5,930 | Insurance broker organization code? | 3 |
|
WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 ) |
Policy contract number | OR406 |
Policy instance | 6 |
Insurance contract or identification number | OR406 | Number of Individuals Covered | 379 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $9,900 | Total amount of fees paid to insurance company | USD $19,801 | 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 | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $198,007 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,900 | Amount paid for insurance broker fees | 19801 | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE FEE | Insurance broker organization code? | 3 |
|
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
Policy contract number | 10042154 |
Policy instance | 4 |
Insurance contract or identification number | 10042154 | Number of Individuals Covered | 518 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $3,312,216 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 |
|
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
Policy contract number | 1682 |
Policy instance | 2 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 898 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $53,619 | Total amount of fees paid to insurance company | USD $1,688 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $5,431,705 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $40,265 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1688 | Additional information about fees paid to insurance broker | BONUS |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 163529 |
Policy instance | 4 |
Insurance contract or identification number | 163529 | Number of Individuals Covered | 747 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $10,167 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Life Insurance Welfare Benefit | No | 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 $5,942 | Insurance broker organization code? | 3 |
|
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 163529 |
Policy instance | 5 |
Insurance contract or identification number | 163529 | Number of Individuals Covered | 747 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $12,200 | Total amount of fees paid to insurance company | USD $0 | 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 | No | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | 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 $8,240 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 6 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 455 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | 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 | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $87,457 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | 4067 |
Policy instance | 1 |
Insurance contract or identification number | 4067 | Number of Individuals Covered | 638 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $13,934 | 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 number | 163529 |
Policy instance | 3 |
Insurance contract or identification number | 163529 | Number of Individuals Covered | 958 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $13,280 | Total amount of fees paid to insurance company | USD $0 | 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 | No | 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 $9,197 | Insurance broker organization code? | 3 |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | 4067 |
Policy instance | 1 |
Insurance contract or identification number | 4067 | Number of Individuals Covered | 638 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $12,556 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | OR099991 |
Policy instance | 2 |
Insurance contract or identification number | OR099991 | Number of Individuals Covered | 751 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2017-09-30 | Total amount of commissions paid to insurance broker | USD $27,820 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $201,457 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,820 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | KIBBLE AND PRENTICE HOLDING COMPANY |
|
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
Policy contract number | 1682 |
Policy instance | 3 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 853 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $52,365 | Total amount of fees paid to insurance company | USD $1,740 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,793,937 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $52,365 | Amount paid for insurance broker fees | 1740 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | KIBBLE AND PRENTICE HOLDING COMPANY |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 4 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 459 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $87,279 | 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 number | 163529 |
Policy instance | 5 |
Insurance contract or identification number | 163529 | Number of Individuals Covered | 788 | Insurance policy start date | 2017-09-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $11,014 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,014 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | USI INSURANCE SERVICES LLC |
|
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
Policy contract number | 1682 |
Policy instance | 1 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 735 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $86,436 | Total amount of fees paid to insurance company | USD $1,068 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $3,794,971 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $86,436 | Amount paid for insurance broker fees | 1068 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | USI NORTHWEST |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 2 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 435 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $81,197 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | OR099991 |
Policy instance | 3 |
Insurance contract or identification number | OR099991 | Number of Individuals Covered | 660 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $59,179 | Total amount of fees paid to insurance company | USD $8,319 | Are there contracts with allocated funds for individual policies? | No | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $371,375 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $59,179 | Amount paid for insurance broker fees | 8319 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | USI NORTHWEST |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | 4067 |
Policy instance | 4 |
Insurance contract or identification number | 4067 | Number of Individuals Covered | 735 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $13,406 | 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 number | 1682 |
Policy instance | 1 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 720 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $77,846 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $3,413,911 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $77,846 | Insurance broker organization code? | 3 | Insurance broker name | USI NORTHWEST |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 2 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 424 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $76,040 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | OR099991 |
Policy instance | 3 |
Insurance contract or identification number | OR099991 | Number of Individuals Covered | 608 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $37,861 | Total amount of fees paid to insurance company | USD $3,973 | Are there contracts with allocated funds for individual policies? | No | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $229,534 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $37,861 | Amount paid for insurance broker fees | 3973 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | USI NORTHWEST |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | 4067 |
Policy instance | 4 |
Insurance contract or identification number | 4067 | Number of Individuals Covered | 696 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $12,110 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 2 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 406 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $67,928 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | OR099991 |
Policy instance | 3 |
Insurance contract or identification number | OR099991 | Number of Individuals Covered | 715 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $36,936 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $224,469 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,936 | Insurance broker organization code? | 3 | Insurance broker name | USI NORTHWEST |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | 4067 |
Policy instance | 4 |
Insurance contract or identification number | 4067 | Number of Individuals Covered | 696 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $12,476 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
Policy contract number | 1682 |
Policy instance | 1 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 680 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $68,695 | Total amount of fees paid to insurance company | USD $794 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $3,024,265 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $68,695 | Amount paid for insurance broker fees | 794 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | USI NORTHWEST |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | 4067 |
Policy instance | 4 |
Insurance contract or identification number | 4067 | Number of Individuals Covered | 696 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $12,024 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
Policy contract number | 1682 |
Policy instance | 1 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 617 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $72,487 | Total amount of fees paid to insurance company | USD $763 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $2,599,086 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $72,487 | Amount paid for insurance broker fees | 763 | Additional information about fees paid to insurance broker | BONUS | Insurance broker organization code? | 3 | Insurance broker name | USI NORTHWEST |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 2 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 378 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $63,806 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | OR099991 |
Policy instance | 3 |
Insurance contract or identification number | OR099991 | Number of Individuals Covered | 678 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $33,730 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $204,667 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $33,730 | Insurance broker organization code? | 3 | Insurance broker name | USI NORTHWEST |
|
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
Policy contract number | 1682 |
Policy instance | 1 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 575 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $53,164 | Total amount of fees paid to insurance company | USD $663 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $2,292,512 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | 4067 |
Policy instance | 4 |
Insurance contract or identification number | 4067 | Number of Individuals Covered | 639 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $12,247 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
Policy contract number | OR099991 |
Policy instance | 3 |
Insurance contract or identification number | OR099991 | Number of Individuals Covered | 643 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $32,421 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $196,984 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 2 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 346 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $58,002 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 03596 |
Policy instance | 3 |
Insurance contract or identification number | 03596 | Number of Individuals Covered | 197 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $19,818 | Total amount of fees paid to insurance company | USD $3,381 | Are there contracts with allocated funds for individual policies? | No | 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 | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $229,488 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12337796 |
Policy instance | 2 |
Insurance contract or identification number | 12337796 | Number of Individuals Covered | 335 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $54,741 | 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 number | 1682 |
Policy instance | 1 |
Insurance contract or identification number | 1682 | Number of Individuals Covered | 504 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $57,278 | Total amount of fees paid to insurance company | USD $2 | Are there contracts with allocated funds for individual policies? | No | 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 | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | 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 | Welfare Benefit Premiums Paid to Carrier | USD $2,392,788 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CASCADE CENTERS INC. (National Association of Insurance Commissioners NAIC id number: 62133 ) |
Policy contract number | 4067 |
Policy instance | 4 |
Insurance contract or identification number | 4067 | Number of Individuals Covered | 631 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $14,409 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|