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TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN 401k Plan overview

Plan NameTERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN
Plan identification number 501

TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

TERWILLIGER PLAZA, INC. has sponsored the creation of one or more 401k plans.

Company Name:TERWILLIGER PLAZA, INC.
Employer identification number (EIN):930477890
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about TERWILLIGER PLAZA, INC.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 2058-10-06
Company Identification Number: 6068415
Legal Registered Office Address: 2545 SW TERWILLIGER BLVD

PORTLAND
United States of America (USA)
97201

More information about TERWILLIGER PLAZA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-10-01ANGELA DOMS2024-02-27
5012021-10-01JUDY O'DONNELL2023-07-10
5012020-10-01JUDY O'DONNELL2022-07-12
5012019-10-01JUDY O'DONNELL2021-07-19

Plan Statistics for TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN

401k plan membership statisitcs for TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN

Measure Date Value
2022: TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN 2022 401k membership
Total participants, beginning-of-year2022-10-01129
Total number of active participants reported on line 7a of the Form 55002022-10-01129
Number of retired or separated participants receiving benefits2022-10-010
Number of other retired or separated participants entitled to future benefits2022-10-010
Total of all active and inactive participants2022-10-01129
Number of employers contributing to the scheme2022-10-010
2021: TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01126
Total number of active participants reported on line 7a of the Form 55002021-10-01123
Number of retired or separated participants receiving benefits2021-10-010
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-01123
Number of employers contributing to the scheme2021-10-010
2020: TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01108
Total number of active participants reported on line 7a of the Form 55002020-10-01126
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01126
Number of employers contributing to the scheme2020-10-010
2019: TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01107
Total number of active participants reported on line 7a of the Form 55002019-10-01108
Number of retired or separated participants receiving benefits2019-10-010
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01108
Number of employers contributing to the scheme2019-10-010

Form 5500 Responses for TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN

2022: TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN 2022 form 5500 responses
2022-10-01Type of plan entitySingle employer plan
2022-10-01Plan funding arrangement – InsuranceYes
2022-10-01Plan benefit arrangement – InsuranceYes
2021: TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – InsuranceYes
2020: TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – InsuranceYes
2019: TERWILLIGER PLAZA, INC. SHORT TERM DISABILITY PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01First time form 5500 has been submittedYes
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK0752557
Policy instance 1
Insurance contract or identification numberLK0752557
Number of Individuals Covered129
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Total amount of commissions paid to insurance brokerUSD $5,935
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $5,935
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK752557
Policy instance 1
Insurance contract or identification numberLK752557
Number of Individuals Covered126
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $17,396
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $17,396
Amount paid for insurance broker fees0
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK752557
Policy instance 1
Insurance contract or identification numberLK752557
Number of Individuals Covered126
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $761
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Welfare Benefit Premiums Paid to CarrierUSD $43,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees761
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK752557
Policy instance 1
Insurance contract or identification numberLK752557
Number of Individuals Covered108
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $517
Total amount of fees paid to insurance companyUSD $827
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $517
Amount paid for insurance broker fees827
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3

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