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COLUMBIA INDUSTRIES LLC 401k Plan overview

Plan NameCOLUMBIA INDUSTRIES LLC
Plan identification number 501

COLUMBIA INDUSTRIES LLC Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

COLUMBIA INDUSTRIES LLC has sponsored the creation of one or more 401k plans.

Company Name:COLUMBIA INDUSTRIES LLC
Employer identification number (EIN):412177061
NAIC Classification:333200

Additional information about COLUMBIA INDUSTRIES LLC

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2005-05-26
Company Identification Number: 29083292
Legal Registered Office Address: 5775 NE WAGON DRIVE

HILLSBORO
United States of America (USA)
97124

More information about COLUMBIA INDUSTRIES LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COLUMBIA INDUSTRIES LLC

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-02-01
5012015-02-01JACK FULLER DEBRA A DIMONE2016-06-28
5012015-02-01
5012014-02-01JACK FULLER
5012013-02-01JACK FULLER

Plan Statistics for COLUMBIA INDUSTRIES LLC

401k plan membership statisitcs for COLUMBIA INDUSTRIES LLC

Measure Date Value
2017: COLUMBIA INDUSTRIES LLC 2017 401k membership
Total participants, beginning-of-year2017-02-01146
Total number of active participants reported on line 7a of the Form 55002017-02-01146
Number of retired or separated participants receiving benefits2017-02-010
Number of other retired or separated participants entitled to future benefits2017-02-010
Total of all active and inactive participants2017-02-01146
2015: COLUMBIA INDUSTRIES LLC 2015 401k membership
Total participants, beginning-of-year2015-02-01169
Total number of active participants reported on line 7a of the Form 55002015-02-01146
Number of retired or separated participants receiving benefits2015-02-010
Number of other retired or separated participants entitled to future benefits2015-02-010
Total of all active and inactive participants2015-02-01146
2014: COLUMBIA INDUSTRIES LLC 2014 401k membership
Total participants, beginning-of-year2014-02-01185
Total number of active participants reported on line 7a of the Form 55002014-02-01169
Number of retired or separated participants receiving benefits2014-02-010
Number of other retired or separated participants entitled to future benefits2014-02-010
Total of all active and inactive participants2014-02-01169
2013: COLUMBIA INDUSTRIES LLC 2013 401k membership
Total participants, beginning-of-year2013-02-01144
Total number of active participants reported on line 7a of the Form 55002013-02-01185
Total of all active and inactive participants2013-02-01185
Total participants2013-02-010

Form 5500 Responses for COLUMBIA INDUSTRIES LLC

2017: COLUMBIA INDUSTRIES LLC 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2015: COLUMBIA INDUSTRIES LLC 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Submission has been amendedYes
2015-02-01This submission is the final filingNo
2015-02-01This return/report is a short plan year return/report (less than 12 months)No
2015-02-01Plan is a collectively bargained planNo
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: COLUMBIA INDUSTRIES LLC 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: COLUMBIA INDUSTRIES LLC 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10015212
Policy instance 2
Insurance contract or identification number10015212
Number of Individuals Covered160
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $8,546
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $712,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $8,546
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUNKNOWN
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00536649
Policy instance 1
Insurance contract or identification number00536649
Number of Individuals Covered70
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $9,161
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $119,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,311
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker namePACIFIC ADVISORS OF OREGON, LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0377382
Policy instance 8
Insurance contract or identification numberR0377382
Number of Individuals Covered3
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $731
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $10,460
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number226518
Policy instance 7
Insurance contract or identification number226518
Number of Individuals Covered146
Insurance policy start date2015-01-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $350
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,062
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 number000400001000
Policy instance 6
Insurance contract or identification number000400001000
Number of Individuals Covered27
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $1,420
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,467
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 number000010202275
Policy instance 5
Insurance contract or identification number000010202275
Number of Individuals Covered90
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $2,290
Other welfare benefits providedWEEKLY INCOME
Welfare Benefit Premiums Paid to CarrierUSD $25,606
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 number000010202274
Policy instance 4
Insurance contract or identification number000010202274
Number of Individuals Covered90
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $2,681
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,307
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 number000010202273
Policy instance 3
Insurance contract or identification number000010202273
Number of Individuals Covered90
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $1,207
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $9,976
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 number00001D029971
Policy instance 2
Insurance contract or identification number00001D029971
Number of Individuals Covered76
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $3,217
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $91,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract numberORLG 100433
Policy instance 1
Insurance contract or identification numberORLG 100433
Number of Individuals Covered213
Insurance policy start date2015-02-01
Insurance policy end date2016-01-31
Total amount of commissions paid to insurance brokerUSD $18,729
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $902,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0377382
Policy instance 3
Insurance contract or identification numberR0377382
Number of Individuals Covered169
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $7,033
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,001
Insurance broker organization code?3
Insurance broker nameJOSEPH A RUGGIERO
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number226518
Policy instance 2
Insurance contract or identification number226518
Number of Individuals Covered146
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $5,036
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $144,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,704
Insurance broker organization code?3
Insurance broker nameMONTGOMERY & GRAHAM INC
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract numberORLG 100433
Policy instance 1
Insurance contract or identification numberORLG 100433
Number of Individuals Covered368
Insurance policy start date2014-02-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $21,769
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,395,619
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,769
Insurance broker organization code?3
Insurance broker nameBCI GROUP
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0377382
Policy instance 3
Insurance contract or identification numberR0377382
Number of Individuals Covered185
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $6,436
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,436
Insurance broker organization code?3
Insurance broker nameJOSEPH ALBERT RUGGIERO
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number226518
Policy instance 2
Insurance contract or identification number226518
Number of Individuals Covered166
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $4,522
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $144,908
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,522
Insurance broker organization code?3
Insurance broker nameMONTGOMERY & GRAHAM INC
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract numberORLG 100433
Policy instance 1
Insurance contract or identification numberORLG 100433
Number of Individuals Covered165
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $22,894
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,327,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,894
Insurance broker organization code?3
Insurance broker nameCURTIS WARNER

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