401k Plan data: THE OLSSON INDUSTRIAL ELECTRIC GROUP HEALTH PLAN plan

THE OLSSON INDUSTRIAL ELECTRIC GROUP HEALTH PLAN 401k Plan overview

Plan Name	THE OLSSON INDUSTRIAL ELECTRIC GROUP HEALTH PLAN
Plan identification number	501

THE OLSSON INDUSTRIAL ELECTRIC GROUP HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	SELECT distinct(Description) AS Description FROM 401k_benefit_codes LEFT JOIN 401k_benefit_code_description ON BenefitCode=Code COLLATE utf8_unicode_ci WHERE EIN='930826848' AND PlanID='501'

401k Sponsoring company profile

OLSSON INDUSTRIAL ELECTRIC, INC. has sponsored the creation of one or more 401k plans.

Company Name: OLSSON INDUSTRIAL ELECTRIC, INC.

Employer identification number (EIN): 930826848

NAIC Classification: 238210
NAIC Description: Electrical Contractors and Other Wiring Installation Contractors

Additional information about OLSSON INDUSTRIAL ELECTRIC, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 1982-08-11

Company Identification Number: 16250714

Legal Registered Office Address: 780 COMMERCIAL ST SE STE 100

SALEM
United States of America (USA)
97301

More information about OLSSON INDUSTRIAL ELECTRIC, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE OLSSON INDUSTRIAL ELECTRIC GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-04-01 DUSTIN STAPLETON 2024-11-12
501 2022-04-01 DUSTIN STAPLETON 2023-10-17
501 2022-04-01 DUSTIN STAPLETON 2024-11-12
501 2021-04-01 DUSTIN STAPLETON 2023-01-06
501 2021-04-01 DUSTIN STAPLETON 2024-11-08
501 2020-04-01 DUSTIN STAPLETON 2021-10-21
501 2020-04-01 DUSTIN STAPLETON 2024-11-12
501 2019-04-01 SHELLY WALTER 2020-10-12
501 2019-04-01 DUSTIN STAPLETON 2024-11-12
501 2018-04-01 SHELLY WALTER 2019-09-05
501 2017-04-01
501 2016-04-01
501 2015-04-01 JOHN S BOETTCHER
501 2014-04-01 JOHN S BOETTCHER
501 2013-04-01 JOHN S BOETTCHER
501 2012-04-01 JOHN E BOETTCHER
501 2011-04-01 CHARLES I GROVE
501 2008-04-01 E T OLSSEN
SELECT Description,401k_plan_data.* , ValueType,YEAR(Date) AS Year FROM 401k_plan_data_930826848 AS 401k_plan_data LEFT JOIN 401k_plan_data_naming ON 401k_plan_data_naming.FieldName= 401k_plan_data.FieldName WHERE EIN='930826848' AND PlanID='501' AND (DataType='SCHED_R_PART1' OR DataType='F_SCH_H') AND Description IS NOT NULL ORDER BY Date DESC , 401k_plan_data.FieldName DESC

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-04-01	DUSTIN STAPLETON	2024-11-12
501	2022-04-01	DUSTIN STAPLETON	2023-10-17
501	2022-04-01	DUSTIN STAPLETON	2024-11-12
501	2021-04-01	DUSTIN STAPLETON	2023-01-06
501	2021-04-01	DUSTIN STAPLETON	2024-11-08
501	2020-04-01	DUSTIN STAPLETON	2021-10-21
501	2020-04-01	DUSTIN STAPLETON	2024-11-12
501	2019-04-01	SHELLY WALTER	2020-10-12
501	2019-04-01	DUSTIN STAPLETON	2024-11-12
501	2018-04-01	SHELLY WALTER	2019-09-05
501	2017-04-01
501	2016-04-01
501	2015-04-01	JOHN S BOETTCHER
501	2014-04-01	JOHN S BOETTCHER
501	2013-04-01	JOHN S BOETTCHER
501	2012-04-01	JOHN E BOETTCHER
501	2011-04-01	CHARLES I GROVE
501	2008-04-01	E T OLSSEN

Insurance Providers Used on plan

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

Policy contract number

753982

Policy instance

Insurance contract or identification number	753982
Number of Individuals Covered	231
Insurance policy start date	2023-04-01
Insurance policy end date	2024-03-31
Total amount of commissions paid to insurance broker	USD $11,447
Total amount of fees paid to insurance company	USD $287
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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
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

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100023870

Policy instance

Insurance contract or identification number	40000100023870
Number of Individuals Covered	235
Insurance policy start date	2023-04-01
Insurance policy end date	2024-03-31
Total amount of commissions paid to insurance broker	USD $13,772
Total amount of fees paid to insurance company	USD $4,426
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
Welfare Benefit Premiums Paid to Carrier	USD $91,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INOVA EMPLOYEE ASSISTANCE (National Association of Insurance Commissioners NAIC id number: 54199 )

Policy contract number

Policy instance

Insurance contract or identification number	00
Number of Individuals Covered	310
Insurance policy start date	2022-04-15
Insurance policy end date	2023-04-14
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 $3,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 )

Policy contract number

G0043229

Policy instance

Insurance contract or identification number	G0043229
Number of Individuals Covered	175
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $26,779
Total amount of fees paid to insurance company	USD $1,900
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $906,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100023870

Policy instance

INOVA EMPLOYEE ASSISTANCE (National Association of Insurance Commissioners NAIC id number: 54199 )

Policy contract number

Policy instance

PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 )

Policy contract number

G0035854

Policy instance

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

Policy contract number

753982

Policy instance

PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 )

Policy contract number

G0043229

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100023870

Policy instance

PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 )

Policy contract number

G0035854

Policy instance

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

Policy contract number

753982

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100023870

Policy instance

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

Policy contract number

920684

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100023870

Policy instance

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

Policy contract number

920684

Policy instance

Insurance contract or identification number	920684
Number of Individuals Covered	184
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $36,667
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $737,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10241078

Policy instance

Insurance contract or identification number	10241078
Number of Individuals Covered	189
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $24,977
Total amount of fees paid to insurance company	USD $2,641
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $235,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10241078

Policy instance

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

Policy contract number

753982

Policy instance

Insurance contract or identification number	753982
Number of Individuals Covered	103
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $1,367
Total amount of fees paid to insurance company	USD $79
Vision Insurance Welfare Benefit	Yes
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

RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

15005548

Policy instance

Insurance contract or identification number	15005548
Number of Individuals Covered	100
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
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 $3,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 )

Policy contract number

G0035854

Policy instance

Insurance contract or identification number	G0035854
Number of Individuals Covered	405
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $36,191
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,759,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 )

Policy contract number

G0035854

Policy instance

Insurance contract or identification number	G0035854
Number of Individuals Covered	385
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $35,963
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,598,294
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

753982

Policy instance

Insurance contract or identification number	753982
Number of Individuals Covered	184
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $12,492
Total amount of fees paid to insurance company	USD $1,436
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10241078

Policy instance

Insurance contract or identification number	10241078
Number of Individuals Covered	191
Insurance policy start date	2019-04-01
Insurance policy end date	2020-03-31
Total amount of commissions paid to insurance broker	USD $11,900
Total amount of fees paid to insurance company	USD $3,165
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
Welfare Benefit Premiums Paid to Carrier	USD $79,333
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1070494

Policy instance

Insurance contract or identification number	1070494
Number of Individuals Covered	167
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,900
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $54,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 53902 )

Policy contract number

10036819

Policy instance

Insurance contract or identification number	10036819
Number of Individuals Covered	193
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $22,202
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $509,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10241078

Policy instance

RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

15005548

Policy instance

Insurance contract or identification number	15005548
Number of Individuals Covered	100
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
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 $3,000
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

753982

Policy instance

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

Policy contract number

753982

Policy instance

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

Policy contract number

753982

Policy instance

RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

15005548

Policy instance

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1002683

Policy instance

PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 )

Policy contract number

G0035854

Policy instance

RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

15005548

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30032387

Policy instance

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

Policy contract number

106044

Policy instance

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1002683

Policy instance

RELIANT BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

15005548

Policy instance

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

Policy contract number

106044

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30032387

Policy instance

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1002683

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30032387

Policy instance

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1002683

Policy instance

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

Policy contract number

106044

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30032387

Policy instance

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1002683

Policy instance

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

Policy contract number

106044

Policy instance

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

Policy contract number

106044

Policy instance

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1002683

Policy instance

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Company Name:	OLSSON INDUSTRIAL ELECTRIC, INC.
Employer identification number (EIN):	930826848
NAIC Classification:	238210
NAIC Description:	Electrical Contractors and Other Wiring Installation Contractors

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	1982-08-11
Company Identification Number:	16250714
Legal Registered Office Address:	780 COMMERCIAL ST SE STE 100 SALEM United States of America (USA) 97301