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VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 401k Plan overview

Plan NameVINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM
Plan identification number 501

VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

VINYL NORTHWEST, LLC DBA PELLA-VINYL PORTLAND OPERATIONS has sponsored the creation of one or more 401k plans.

Company Name:VINYL NORTHWEST, LLC DBA PELLA-VINYL PORTLAND OPERATIONS
Employer identification number (EIN):200876482
NAIC Classification:321900

Additional information about VINYL NORTHWEST, LLC DBA PELLA-VINYL PORTLAND OPERATIONS

Jurisdiction of Incorporation: Iowa Secretary of State Business Entities
Incorporation Date: 2004-01-22
Company Identification Number: 289586
Legal Registered Office Address: 3106 INGERSOLL AVENUE

DES MOINES
United States of America (USA)
50312

More information about VINYL NORTHWEST, LLC DBA PELLA-VINYL PORTLAND OPERATIONS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01LANCE TRASTER2023-10-03
5012021-01-01LANCE TRASTER2022-10-14
5012020-01-01TRICIA VANZEE2021-09-15
5012019-01-01TRICIA L VANZEE2020-10-15
5012019-01-01TRICIA L VANZEE2020-10-01
5012018-01-01TRICIA L VANZEE2019-09-15
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01TRICIA L VANZEE
5012012-09-01TRICIA L VANZEE
5012011-09-01ROB BRADLEY
5012010-09-01TRICIA L VANZEE
5012009-09-01TRICIA L VANZEE

Plan Statistics for VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM

401k plan membership statisitcs for VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM

Measure Date Value
2022: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2022 401k membership
Total participants, beginning-of-year2022-01-01104
Total number of active participants reported on line 7a of the Form 55002022-01-01225
Number of retired or separated participants receiving benefits2022-01-011
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01226
Number of employers contributing to the scheme2022-01-010
2021: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2021 401k membership
Total participants, beginning-of-year2021-01-01113
Total number of active participants reported on line 7a of the Form 55002021-01-01104
Total of all active and inactive participants2021-01-01104
Total participants2021-01-01104
2020: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2020 401k membership
Total participants, beginning-of-year2020-01-01178
Total number of active participants reported on line 7a of the Form 55002020-01-01220
Total of all active and inactive participants2020-01-01220
Total participants2020-01-01220
2019: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2019 401k membership
Total participants, beginning-of-year2019-01-01159
Total number of active participants reported on line 7a of the Form 55002019-01-01158
Total of all active and inactive participants2019-01-01158
Total participants2019-01-01158
2018: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2018 401k membership
Total participants, beginning-of-year2018-01-01130
Total number of active participants reported on line 7a of the Form 55002018-01-01159
Total of all active and inactive participants2018-01-01159
Total participants2018-01-01159
2017: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2017 401k membership
Total participants, beginning-of-year2017-01-01141
Total number of active participants reported on line 7a of the Form 55002017-01-01130
Total of all active and inactive participants2017-01-01130
Total participants2017-01-01130
2016: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2016 401k membership
Total participants, beginning-of-year2016-01-01139
Total number of active participants reported on line 7a of the Form 55002016-01-01141
Total of all active and inactive participants2016-01-01141
Total participants2016-01-01141
2015: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2015 401k membership
Total participants, beginning-of-year2015-01-01109
Total number of active participants reported on line 7a of the Form 55002015-01-01139
Total of all active and inactive participants2015-01-01139
Total participants2015-01-01139
2014: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2014 401k membership
Total participants, beginning-of-year2014-01-01112
Total number of active participants reported on line 7a of the Form 55002014-01-01109
Total of all active and inactive participants2014-01-01109
Total participants2014-01-01109
2013: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2013 401k membership
Total participants, beginning-of-year2013-01-0193
Total number of active participants reported on line 7a of the Form 55002013-01-01110
Number of retired or separated participants receiving benefits2013-01-012
Total of all active and inactive participants2013-01-01112
Total participants2013-01-01112
2012: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2012 401k membership
Total participants, beginning-of-year2012-09-01140
Total number of active participants reported on line 7a of the Form 55002012-09-0189
Number of retired or separated participants receiving benefits2012-09-014
Total of all active and inactive participants2012-09-0193
Total participants2012-09-0193
2011: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2011 401k membership
Total participants, beginning-of-year2011-09-01156
Total number of active participants reported on line 7a of the Form 55002011-09-01137
Number of retired or separated participants receiving benefits2011-09-013
Total of all active and inactive participants2011-09-01140
Total participants2011-09-01140
2010: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2010 401k membership
Total participants, beginning-of-year2010-09-01165
Total number of active participants reported on line 7a of the Form 55002010-09-01156
Total of all active and inactive participants2010-09-01156
Total participants2010-09-01156
2009: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2009 401k membership
Total participants, beginning-of-year2009-09-01189
Total number of active participants reported on line 7a of the Form 55002009-09-01161
Number of retired or separated participants receiving benefits2009-09-014
Total of all active and inactive participants2009-09-01165
Total participants2009-09-01165

Form 5500 Responses for VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM

2022: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan benefit arrangement – InsuranceYes
2011: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – InsuranceYes
2010: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2010 form 5500 responses
2010-09-01Type of plan entitySingle employer plan
2010-09-01Plan funding arrangement – InsuranceYes
2010-09-01Plan benefit arrangement – InsuranceYes
2009: VINYL NORTHWEST, INC. HEALTH, LIFE INS., DENTAL, VISION, TEMPORARY DISABILITY & LONG TERM 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan 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 number93-0798039
Policy instance 2
Insurance contract or identification number93-0798039
Number of Individuals Covered189
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,316,640
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL150922
Policy instance 1
Insurance contract or identification numberGL150922
Number of Individuals Covered236
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $120,378
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 number1965
Policy instance 3
Insurance contract or identification number1965
Number of Individuals Covered186
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,441,364
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 162685
Policy instance 2
Insurance contract or identification numberG 162685
Number of Individuals Covered217
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $108,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 150922
Policy instance 1
Insurance contract or identification numberGL 150922
Number of Individuals Covered217
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $19,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 150922
Policy instance 1
Insurance contract or identification numberGL 150922
Number of Individuals Covered175
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $19,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 162685
Policy instance 2
Insurance contract or identification numberG 162685
Number of Individuals Covered175
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $89,506
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 number1965
Policy instance 3
Insurance contract or identification number1965
Number of Individuals Covered195
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,465,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 150922
Policy instance 1
Insurance contract or identification numberGL 150922
Number of Individuals Covered158
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $20,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 162685
Policy instance 2
Insurance contract or identification numberG 162685
Number of Individuals Covered158
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,327
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 number1965
Policy instance 3
Insurance contract or identification number1965
Number of Individuals Covered189
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,334,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 150922
Policy instance 1
Insurance contract or identification numberGL 150922
Number of Individuals Covered130
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $19,951
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 162685
Policy instance 2
Insurance contract or identification numberG 162685
Number of Individuals Covered130
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,435
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 number1965
Policy instance 3
Insurance contract or identification number1965
Number of Individuals Covered185
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,062,863
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 number1965
Policy instance 3
Insurance contract or identification number1965
Number of Individuals Covered184
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,135,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 162685
Policy instance 2
Insurance contract or identification numberG 162685
Number of Individuals Covered143
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $1,391
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1391
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameLAMAIR MULOCK CONDON CO.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 150922
Policy instance 1
Insurance contract or identification numberGL 150922
Number of Individuals Covered143
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $403
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $15,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees403
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameLAMAIR MULOCK CONDON CO.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 150922
Policy instance 1
Insurance contract or identification numberGL 150922
Number of Individuals Covered109
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $366
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $16,780
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees366
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameLAMAIR MULOCK CONDON CO.
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1965
Policy instance 3
Insurance contract or identification number1965
Number of Individuals Covered200
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,107,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 162685
Policy instance 2
Insurance contract or identification numberG 162685
Number of Individuals Covered109
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $1,141
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1141
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameLAMAIR MULOCK CONDON CO.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 150922
Policy instance 1
Insurance contract or identification numberGL 150922
Number of Individuals Covered111
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of fees paid to insurance companyUSD $565
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $16,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees565
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameLAMAIR MULOCK CONDON CO.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 162685
Policy instance 2
Insurance contract or identification numberG 162685
Number of Individuals Covered111
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of fees paid to insurance companyUSD $1,835
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $51,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1835
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
Insurance broker nameLAMAIR MULOCK CONDON CO.
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1965
Policy instance 3
Insurance contract or identification number1965
Number of Individuals Covered209
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,240,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG 162685
Policy instance 3
Insurance contract or identification numberG 162685
Number of Individuals Covered119
Insurance policy start date2013-02-01
Insurance policy end date2013-12-31
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,875
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 number1965
Policy instance 2
Insurance contract or identification number1965
Number of Individuals Covered220
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $15,158
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,076,714
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,158
Insurance broker organization code?3
Insurance broker nameLA MAIR-MULOCK-CONDON CO
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL 150922
Policy instance 1
Insurance contract or identification numberGL 150922
Number of Individuals Covered119
Insurance policy start date2013-02-01
Insurance policy end date2013-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $14,113
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 number1965
Policy instance 2
Insurance contract or identification number1965
Number of Individuals Covered244
Insurance policy start date2012-09-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,532
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $445,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,532
Insurance broker organization code?3
Insurance broker nameFRANK W. BERLIN ASSOC. LLC
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number151068
Policy instance 1
Insurance contract or identification number151068
Number of Individuals Covered130
Insurance policy start date2012-06-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,436
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,532
Insurance broker organization code?3
Insurance broker nameLAMAIR MULOCK CONDON CO
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number151068
Policy instance 1
Insurance contract or identification number151068
Number of Individuals Covered137
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $4,052
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 number1965
Policy instance 2
Insurance contract or identification number1965
Number of Individuals Covered244
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $14,299
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,294,505
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 number151068
Policy instance 1
Insurance contract or identification number151068
Number of Individuals Covered155
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $5,525
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
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 number1965
Policy instance 2
Insurance contract or identification number1965
Number of Individuals Covered283
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $15,181
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,184,646
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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