401k Plan data: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN plan

YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 401k Plan overview

Plan Name	YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN
Plan identification number	501

YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN Benefits

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

401k Sponsoring company profile

YMCA OF COLUMBIA-WILLAMETTE has sponsored the creation of one or more 401k plans.

Company Name: YMCA OF COLUMBIA-WILLAMETTE

Employer identification number (EIN): 930386981

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2018-01-01
501 2018-01-01 DENISE LARUE 2020-07-27
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 STEVEN D HUNTER
501 2011-01-01 STEVEN D HUNTER
501 2009-01-01 HEATHER JACKSON HEATHER JACKSON 2010-07-29

Plan Statistics for YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN

401k plan membership statisitcs for YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN

Measure Date Value
2018: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 122
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 122
Number of employers contributing to the scheme 2018-01-01 0
2017: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 122
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 122
2016: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 109
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 122
Total of all active and inactive participants 2016-01-01 122
2015: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 124
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 109
Total of all active and inactive participants 2015-01-01 109
2014: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 126
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 124
Total of all active and inactive participants 2014-01-01 124
2013: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 126
Total of all active and inactive participants 2013-01-01 126
2012: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 153
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 135
Total of all active and inactive participants 2012-01-01 135
2011: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 156
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 153
Total of all active and inactive participants 2011-01-01 153
2009: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 246
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 212
Total of all active and inactive participants 2009-01-01 212
Total participants 2009-01-01 212

Measure	Date	Value
2018: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	122
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	122
Number of employers contributing to the scheme	2018-01-01	0
2017: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	122
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	122
2016: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	109
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	122
Total of all active and inactive participants	2016-01-01	122
2015: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	124
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	109
Total of all active and inactive participants	2015-01-01	109
2014: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	126
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	124
Total of all active and inactive participants	2014-01-01	124
2013: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	126
Total of all active and inactive participants	2013-01-01	126
2012: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	153
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	135
Total of all active and inactive participants	2012-01-01	135
2011: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	156
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	153
Total of all active and inactive participants	2011-01-01	153
2009: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	246
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	212
Total of all active and inactive participants	2009-01-01	212
Total participants	2009-01-01	212

Form 5500 Responses for YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN

2018: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: YMCA OF COLUMBIA-WILLAMETTE WELFARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

Q6060

Policy instance

Insurance contract or identification number	Q6060
Number of Individuals Covered	37
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,941
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $18,420
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,843
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

648440

Policy instance

Insurance contract or identification number	648440
Number of Individuals Covered	146
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,489
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
Commission paid to Insurance Broker	USD $1,708
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

3483

Policy instance

Insurance contract or identification number	3483
Number of Individuals Covered	2
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $562
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $359
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

109210

Policy instance

Insurance contract or identification number	109210
Number of Individuals Covered	180
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $22,609
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,004,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,609
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

3483

Policy instance

Insurance contract or identification number	3483
Number of Individuals Covered	4
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,133
Total amount of fees paid to insurance company	USD $21
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,133
Amount paid for insurance broker fees	21
Additional information about fees paid to insurance broker	RETENTION BONUS
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

648440

Policy instance

Insurance contract or identification number	648440
Number of Individuals Covered	117
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $2,015
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
Commission paid to Insurance Broker	USD $2,015
Amount paid for insurance broker fees	0
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

17598

Policy instance

Insurance contract or identification number	17598
Number of Individuals Covered	58
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $805
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $9,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $485
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	HAILEY N. PARKER

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

109210

Policy instance

Insurance contract or identification number	109210
Number of Individuals Covered	179
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $22,863
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $795,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,863
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

109210

Policy instance

Insurance contract or identification number	109210
Number of Individuals Covered	232
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $13,315
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $650,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,315
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

3483

Policy instance

Insurance contract or identification number	3483
Number of Individuals Covered	6
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,692
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $59,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,692
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

648440

Policy instance

Insurance contract or identification number	648440
Number of Individuals Covered	109
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,254
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
Commission paid to Insurance Broker	USD $2,254
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

648440

Policy instance

Insurance contract or identification number	648440
Number of Individuals Covered	124
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,169
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,169
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

ORLG 109210

Policy instance

Insurance contract or identification number	ORLG 109210
Number of Individuals Covered	115
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $15,172
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $624,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,172
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

3483

Policy instance

Insurance contract or identification number	3483
Number of Individuals Covered	16
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,081
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $89,932
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,081
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

648440

Policy instance

Insurance contract or identification number	648440
Number of Individuals Covered	126
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,354
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,354
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

3483

Policy instance

Insurance contract or identification number	3483
Number of Individuals Covered	17
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,764
Total amount of fees paid to insurance company	USD $87
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $115,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,764
Amount paid for insurance broker fees	87
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

ORLG 109210

Policy instance

Insurance contract or identification number	ORLG 109210
Number of Individuals Covered	122
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $14,454
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $613,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,454
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

ORLG 109210

Policy instance

Insurance contract or identification number	ORLG 109210
Number of Individuals Covered	137
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $13,880
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $672,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,880
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

648440

Policy instance

Insurance contract or identification number	648440
Number of Individuals Covered	135
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,200
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,200
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

3483

Policy instance

Insurance contract or identification number	3483
Number of Individuals Covered	25
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,983
Total amount of fees paid to insurance company	USD $126
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $132,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,983
Amount paid for insurance broker fees	126
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

648440

Policy instance

Insurance contract or identification number	648440
Number of Individuals Covered	153
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,201
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	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

3483

Policy instance

Insurance contract or identification number	3483
Number of Individuals Covered	17
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,766
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $119,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

ORLG 109210

Policy instance

Insurance contract or identification number	ORLG 109210
Number of Individuals Covered	124
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $14,485
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $709,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )

Policy contract number

10005666

Policy instance

Insurance contract or identification number	10005666
Number of Individuals Covered	156
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,283
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,283
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

U 4723 A

Policy instance

Insurance contract or identification number	U 4723 A
Number of Individuals Covered	132
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $9,857
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $680,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,857
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

3483

Policy instance

Insurance contract or identification number	3483
Number of Individuals Covered	24
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,231
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $160,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,231
Insurance broker organization code?	3
Insurance broker name	COORDINATED RESOURCES GROUP, INC.

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Company Name:	YMCA OF COLUMBIA-WILLAMETTE
Employer identification number (EIN):	930386981
NAIC Classification:	624100
NAIC Description:	Individual and Family Services

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2018-01-01
501	2018-01-01	DENISE LARUE	2020-07-27
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	STEVEN D HUNTER
501	2011-01-01	STEVEN D HUNTER
501	2009-01-01	HEATHER JACKSON		HEATHER JACKSON	2010-07-29