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SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan NameSIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN
Plan identification number 502

SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover

401k Sponsoring company profile

SIGNATURE NORTHWEST LLC has sponsored the creation of one or more 401k plans.

Company Name:SIGNATURE NORTHWEST LLC
Employer identification number (EIN):201595176
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Additional information about SIGNATURE NORTHWEST LLC

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2004-09-02
Company Identification Number: 23957095
Legal Registered Office Address: 838 SW FIRST AVE STE 210

PORTLAND
United States of America (USA)
97204

More information about SIGNATURE NORTHWEST LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022019-03-01DEREK L LOHREY CPA2020-08-03
5022018-03-01
5022017-03-01
5022016-03-01DEREK L LOHREY

Plan Statistics for SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2019: SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-03-01108
Total number of active participants reported on line 7a of the Form 55002019-03-010
Number of retired or separated participants receiving benefits2019-03-010
Number of other retired or separated participants entitled to future benefits2019-03-010
Total of all active and inactive participants2019-03-010
Number of employers contributing to the scheme2019-03-010
2018: SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-03-01118
Total number of active participants reported on line 7a of the Form 55002018-03-01108
Number of retired or separated participants receiving benefits2018-03-010
Number of other retired or separated participants entitled to future benefits2018-03-010
Total of all active and inactive participants2018-03-01108
Number of employers contributing to the scheme2018-03-010
2017: SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-03-01118
Total number of active participants reported on line 7a of the Form 55002017-03-01102
Number of retired or separated participants receiving benefits2017-03-010
Number of other retired or separated participants entitled to future benefits2017-03-010
Total of all active and inactive participants2017-03-01102
2016: SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-03-01100
Total number of active participants reported on line 7a of the Form 55002016-03-01118
Number of retired or separated participants receiving benefits2016-03-010
Number of other retired or separated participants entitled to future benefits2016-03-010
Total of all active and inactive participants2016-03-01118

Form 5500 Responses for SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN

2019: SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-03-01Type of plan entitySingle employer plan
2019-03-01This submission is the final filingYes
2019-03-01Plan funding arrangement – InsuranceYes
2019-03-01Plan benefit arrangement – InsuranceYes
2018: SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-03-01Type of plan entitySingle employer plan
2018-03-01Plan funding arrangement – InsuranceYes
2018-03-01Plan benefit arrangement – InsuranceYes
2017: SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-03-01Type of plan entitySingle employer plan
2017-03-01Plan funding arrangement – InsuranceYes
2017-03-01Plan benefit arrangement – InsuranceYes
2016: SIGNATURE NORTHWEST, LLC HEALTH AND WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01First time form 5500 has been submittedYes
2016-03-01Submission has been amendedNo
2016-03-01This submission is the final filingNo
2016-03-01This return/report is a short plan year return/report (less than 12 months)No
2016-03-01Plan is a collectively bargained planNo
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4469078
Policy instance 5
Insurance contract or identification numberE4469078
Number of Individuals Covered48
Insurance policy start date2019-03-01
Insurance policy end date2020-02-28
Total amount of commissions paid to insurance brokerUSD $5,795
Total amount of fees paid to insurance companyUSD $1,399
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $39,507
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,337
Amount paid for insurance broker fees363
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1002745
Policy instance 4
Insurance contract or identification number1002745
Number of Individuals Covered3
Insurance policy start date2019-03-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $729
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $729
Amount paid for insurance broker fees0
Insurance broker organization code?3
NEXDENT DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number105
Policy instance 3
Insurance contract or identification number105
Number of Individuals Covered110
Insurance policy start date2019-03-01
Insurance policy end date2020-02-28
Total amount of commissions paid to insurance brokerUSD $3,896
Total amount of fees paid to insurance companyUSD $0
Dental 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 $3,896
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4291753
Policy instance 2
Insurance contract or identification numberE4291753
Number of Individuals Covered14
Insurance policy start date2019-03-01
Insurance policy end date2020-02-28
Total amount of commissions paid to insurance brokerUSD $1,955
Total amount of fees paid to insurance companyUSD $205
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $21,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $833
Amount paid for insurance broker fees66
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberVF461B
Policy instance 1
Insurance contract or identification numberVF461B
Number of Individuals Covered99
Insurance policy start date2019-03-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $311,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4469078
Policy instance 5
Insurance contract or identification numberE4469078
Number of Individuals Covered50
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $7,927
Total amount of fees paid to insurance companyUSD $1,798
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $37,867
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,552
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1002745
Policy instance 4
Insurance contract or identification number1002745
Number of Individuals Covered3
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $896
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $896
Amount paid for insurance broker fees0
Insurance broker organization code?3
NEXDENT DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number105
Policy instance 3
Insurance contract or identification number105
Number of Individuals Covered118
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $5,508
Total amount of fees paid to insurance companyUSD $0
Dental 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 $5,508
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4291753
Policy instance 2
Insurance contract or identification numberE4291753
Number of Individuals Covered23
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $4,287
Total amount of fees paid to insurance companyUSD $842
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $26,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,551
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberVF461B
Policy instance 1
Insurance contract or identification numberVF461B
Number of Individuals Covered96
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $511,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4469078
Policy instance 5
Insurance contract or identification numberE4469078
Number of Individuals Covered53
Insurance policy start date2016-03-01
Insurance policy end date2017-02-28
Total amount of commissions paid to insurance brokerUSD $7,798
Total amount of fees paid to insurance companyUSD $2,689
Other welfare benefits providedHOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $44,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,559
Amount paid for insurance broker fees1245
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameISAACSON INSURANCE AGENCY LLC
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1002745
Policy instance 4
Insurance contract or identification number1002745
Number of Individuals Covered3
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $843
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $843
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameWEST COAST INSURANCE SVCS INC.
NEXDENT DENTAL PLANS, INC. (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number105
Policy instance 3
Insurance contract or identification number105
Number of Individuals Covered118
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $5,889
Total amount of fees paid to insurance companyUSD $0
Dental 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 $5,889
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameWEST COAST INSURANCE SVCS INC.
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4291753
Policy instance 2
Insurance contract or identification numberE4291753
Number of Individuals Covered33
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $6,830
Total amount of fees paid to insurance companyUSD $2,561
Other welfare benefits providedACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $39,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,435
Amount paid for insurance broker fees1158
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameCHRISTINE LYNN MORGESTER
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberVF461B
Policy instance 1
Insurance contract or identification numberVF461B
Number of Individuals Covered104
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $474,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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