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UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 401k Plan overview

Plan NameUNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN
Plan identification number 501

UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

SPADA PROPERTIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:SPADA PROPERTIES, INC.
Employer identification number (EIN):930550021
NAIC Classification:424400

Additional information about SPADA PROPERTIES, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2065-12-23
Company Identification Number: 7715014
Legal Registered Office Address: 8448 NE 33RD DR

PORTLAND
United States of America (USA)
97211

More information about SPADA PROPERTIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01
5012020-12-01
5012019-12-01
5012018-12-01
5012017-12-01TERESA J SPADA
5012016-12-01TERESA J SPADA
5012015-12-01TERESA J. SPADA
5012014-12-01TERESA J. SPADA
5012013-12-01TERESA J. SPADA
5012012-12-01TERESA J. SPADA
5012011-12-01TERESA J. SPADA
5012010-12-01TERESA J. SPADA
5012009-12-01TERESA J. SPADA

Plan Statistics for UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN

401k plan membership statisitcs for UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN

Measure Date Value
2021: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-01544
Total number of active participants reported on line 7a of the Form 55002021-12-01516
Total of all active and inactive participants2021-12-01516
Total participants2021-12-01516
2020: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-01402
Total number of active participants reported on line 7a of the Form 55002020-12-01544
Total of all active and inactive participants2020-12-01544
Total participants2020-12-01544
2019: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01431
Total number of active participants reported on line 7a of the Form 55002019-12-01402
Total of all active and inactive participants2019-12-01402
Total participants2019-12-01402
2018: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-01477
Total number of active participants reported on line 7a of the Form 55002018-12-01431
Total of all active and inactive participants2018-12-01431
Total participants2018-12-01431
2017: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-01404
Total number of active participants reported on line 7a of the Form 55002017-12-01477
Total of all active and inactive participants2017-12-01477
Total participants2017-12-01477
2016: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-01500
Total number of active participants reported on line 7a of the Form 55002016-12-01404
Total of all active and inactive participants2016-12-01404
Total participants2016-12-01404
2015: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-01403
Total number of active participants reported on line 7a of the Form 55002015-12-01500
Number of retired or separated participants receiving benefits2015-12-010
Number of other retired or separated participants entitled to future benefits2015-12-010
Total of all active and inactive participants2015-12-01500
2014: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-01399
Total number of active participants reported on line 7a of the Form 55002014-12-01403
Number of retired or separated participants receiving benefits2014-12-010
Number of other retired or separated participants entitled to future benefits2014-12-010
Total of all active and inactive participants2014-12-01403
2013: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-01336
Total number of active participants reported on line 7a of the Form 55002013-12-01399
Number of retired or separated participants receiving benefits2013-12-010
Number of other retired or separated participants entitled to future benefits2013-12-010
Total of all active and inactive participants2013-12-01399
2012: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-12-01347
Total number of active participants reported on line 7a of the Form 55002012-12-01336
Number of retired or separated participants receiving benefits2012-12-010
Number of other retired or separated participants entitled to future benefits2012-12-010
Total of all active and inactive participants2012-12-01336
2011: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-01303
Total number of active participants reported on line 7a of the Form 55002011-12-01347
Number of retired or separated participants receiving benefits2011-12-010
Number of other retired or separated participants entitled to future benefits2011-12-010
Total of all active and inactive participants2011-12-01347
2010: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-12-01276
Total number of active participants reported on line 7a of the Form 55002010-12-01303
Number of retired or separated participants receiving benefits2010-12-010
Number of other retired or separated participants entitled to future benefits2010-12-010
Total of all active and inactive participants2010-12-01303
2009: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-01250
Total number of active participants reported on line 7a of the Form 55002009-12-01276
Number of retired or separated participants receiving benefits2009-12-010
Number of other retired or separated participants entitled to future benefits2009-12-010
Total of all active and inactive participants2009-12-01276

Form 5500 Responses for UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN

2021: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Plan funding arrangement – General assets of the sponsorYes
2021-12-01Plan benefit arrangement – InsuranceYes
2020: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Plan funding arrangement – General assets of the sponsorYes
2020-12-01Plan benefit arrangement – InsuranceYes
2019: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Plan funding arrangement – General assets of the sponsorYes
2019-12-01Plan benefit arrangement – InsuranceYes
2018: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Plan funding arrangement – General assets of the sponsorYes
2018-12-01Plan benefit arrangement – InsuranceYes
2017: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01Plan funding arrangement – General assets of the sponsorYes
2017-12-01Plan benefit arrangement – InsuranceYes
2016: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Plan funding arrangement – General assets of the sponsorYes
2016-12-01Plan benefit arrangement – InsuranceYes
2015: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – General assets of the sponsorYes
2015-12-01Plan benefit arrangement – InsuranceYes
2014: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingNo
2014-12-01This return/report is a short plan year return/report (less than 12 months)No
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – General assets of the sponsorYes
2014-12-01Plan benefit arrangement – InsuranceYes
2013: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2013 form 5500 responses
2013-12-01Type of plan entitySingle employer plan
2013-12-01Submission has been amendedNo
2013-12-01This submission is the final filingNo
2013-12-01This return/report is a short plan year return/report (less than 12 months)No
2013-12-01Plan is a collectively bargained planNo
2013-12-01Plan funding arrangement – General assets of the sponsorYes
2013-12-01Plan benefit arrangement – InsuranceYes
2012: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2012 form 5500 responses
2012-12-01Type of plan entitySingle employer plan
2012-12-01Submission has been amendedNo
2012-12-01This submission is the final filingNo
2012-12-01This return/report is a short plan year return/report (less than 12 months)No
2012-12-01Plan is a collectively bargained planNo
2012-12-01Plan funding arrangement – General assets of the sponsorYes
2012-12-01Plan benefit arrangement – InsuranceYes
2011: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2011 form 5500 responses
2011-12-01Type of plan entitySingle employer plan
2011-12-01Submission has been amendedNo
2011-12-01This submission is the final filingNo
2011-12-01This return/report is a short plan year return/report (less than 12 months)No
2011-12-01Plan is a collectively bargained planNo
2011-12-01Plan funding arrangement – General assets of the sponsorYes
2011-12-01Plan benefit arrangement – InsuranceYes
2010: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2010 form 5500 responses
2010-12-01Type of plan entitySingle employer plan
2010-12-01Submission has been amendedNo
2010-12-01This submission is the final filingNo
2010-12-01This return/report is a short plan year return/report (less than 12 months)No
2010-12-01Plan is a collectively bargained planNo
2010-12-01Plan funding arrangement – General assets of the sponsorYes
2010-12-01Plan benefit arrangement – InsuranceYes
2009: UNITED SALAD COMPANY MEDICAL/DENTAL INSURANCE PLAN 2009 form 5500 responses
2009-12-01Type of plan entitySingle employer plan
2009-12-01Submission has been amendedNo
2009-12-01This submission is the final filingNo
2009-12-01This return/report is a short plan year return/report (less than 12 months)No
2009-12-01Plan is a collectively bargained planNo
2009-12-01Plan funding arrangement – General assets of the sponsorYes
2009-12-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number18365
Policy instance 1
Insurance contract or identification number18365
Number of Individuals Covered516
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $86,369
Total amount of fees paid to insurance companyUSD $1,965
Welfare Benefit Premiums Paid to CarrierUSD $3,478,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $86,369
Amount paid for insurance broker fees1965
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number18365
Policy instance 1
Insurance contract or identification number18365
Number of Individuals Covered544
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $83,820
Total amount of fees paid to insurance companyUSD $2,392
Welfare Benefit Premiums Paid to CarrierUSD $3,349,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $83,820
Amount paid for insurance broker fees2392
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number18365
Policy instance 1
Insurance contract or identification number18365
Number of Individuals Covered605
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $81,285
Total amount of fees paid to insurance companyUSD $2,851
Welfare Benefit Premiums Paid to CarrierUSD $3,569,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $81,285
Amount paid for insurance broker fees2851
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number18365
Policy instance 1
Insurance contract or identification number18365
Number of Individuals Covered626
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $87,072
Total amount of fees paid to insurance companyUSD $3,000
Welfare Benefit Premiums Paid to CarrierUSD $3,397,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $87,072
Amount paid for insurance broker fees3000
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number18365
Policy instance 1
Insurance contract or identification number18365
Number of Individuals Covered732
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $108,482
Total amount of fees paid to insurance companyUSD $140
Welfare Benefit Premiums Paid to CarrierUSD $3,647,621
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 number10007595
Policy instance 2
Insurance contract or identification number10007595
Number of Individuals Covered223
Insurance policy start date2015-12-01
Insurance policy end date2016-11-30
Total amount of commissions paid to insurance brokerUSD $3,986
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $140,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,986
Amount paid for insurance broker fees0
Additional information about fees paid to insurance broker0
Insurance broker organization code?3
Insurance broker nameGROUP INSURANCE RESOURCES INC.
WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 )
Policy contract numberOR156/Z1822
Policy instance 3
Insurance contract or identification numberOR156/Z1822
Number of Individuals Covered373
Insurance policy start date2015-12-01
Insurance policy end date2016-11-30
Total amount of commissions paid to insurance brokerUSD $6,499
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $6,499
Insurance broker organization code?3
Insurance broker nameGROUP INSURANCE RESOURCES, INC.
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number18365
Policy instance 1
Insurance contract or identification number18365
Number of Individuals Covered842
Insurance policy start date2015-12-01
Insurance policy end date2016-11-30
Total amount of commissions paid to insurance brokerUSD $95,489
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $3,228,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $95,489
Insurance broker organization code?3
Insurance broker nameGROUP INSURANCE RESOURCES, INC.
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number18365
Policy instance 1
Insurance contract or identification number18365
Number of Individuals Covered724
Insurance policy start date2014-12-01
Insurance policy end date2015-11-30
Total amount of commissions paid to insurance brokerUSD $75,806
Total amount of fees paid to insurance companyUSD $2,653
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $2,780,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75,806
Amount paid for insurance broker fees2653
Additional information about fees paid to insurance brokerRETENTION BONUS
Insurance broker organization code?3
Insurance broker nameGROUP INSURANCE RESOURCES, INC.
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10007595
Policy instance 2
Insurance contract or identification number10007595
Number of Individuals Covered322
Insurance policy start date2014-12-01
Insurance policy end date2015-11-30
Total amount of commissions paid to insurance brokerUSD $4,184
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $4,184
Insurance broker organization code?3
Insurance broker nameGROUP INSURANCE RESOURCES INC.
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number18365
Policy instance 2
Insurance contract or identification number18365
Number of Individuals Covered640
Insurance policy start date2013-12-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $70,376
Total amount of fees paid to insurance companyUSD $2,721
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $2,356,721
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,376
Amount paid for insurance broker fees2721
Additional information about fees paid to insurance brokerRETENTION BONUS
Insurance broker organization code?3
Insurance broker nameGROUP INSURANCE RESOURCES, INC.
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10007595
Policy instance 1
Insurance contract or identification number10007595
Number of Individuals Covered181
Insurance policy start date2013-12-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $4,239
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $4,239
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameGROUP INSURANCE RESOURCES, INC.
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number18365
Policy instance 2
Insurance contract or identification number18365
Number of Individuals Covered629
Insurance policy start date2012-12-01
Insurance policy end date2013-11-30
Total amount of commissions paid to insurance brokerUSD $62,457
Total amount of fees paid to insurance companyUSD $2,772
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $2,095,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,457
Amount paid for insurance broker fees2772
Additional information about fees paid to insurance brokerRETENTION BONUS
Insurance broker organization code?3
Insurance broker nameGROUP INSURANCE RESOURCES, INC.
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10007595
Policy instance 1
Insurance contract or identification number10007595
Number of Individuals Covered178
Insurance policy start date2012-12-01
Insurance policy end date2013-11-30
Total amount of commissions paid to insurance brokerUSD $4,207
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $4,207
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameGROUP INSURANCE RESOURCES, INC.
WILLAMETTE DENTAL INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 57069 )
Policy contract numberZ1822
Policy instance 1
Insurance contract or identification numberZ1822
Number of Individuals Covered151
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,448
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10007595
Policy instance 2
Insurance contract or identification number10007595
Number of Individuals Covered166
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $3,878
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number18365
Policy instance 3
Insurance contract or identification number18365
Number of Individuals Covered347
Insurance policy start date2011-12-01
Insurance policy end date2012-11-30
Total amount of commissions paid to insurance brokerUSD $52,971
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number10007595
Policy instance 3
Insurance contract or identification number10007595
Number of Individuals Covered159
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $3,447
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberV3655A
Policy instance 1
Insurance contract or identification numberV3655A
Number of Individuals Covered303
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $51,571
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,719,022
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 numberZ1822
Policy instance 2
Insurance contract or identification numberZ1822
Number of Individuals Covered139
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,154
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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

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