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SUPPLEMENTAL MEDICAL 401k Plan overview

Plan NameSUPPLEMENTAL MEDICAL
Plan identification number 515

SUPPLEMENTAL MEDICAL Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

NORTHWEST PERMANENTE, P.C. has sponsored the creation of one or more 401k plans.

Company Name:NORTHWEST PERMANENTE, P.C.
Employer identification number (EIN):930698548
NAIC Classification:621112
NAIC Description:Offices of Physicians, Mental Health Specialists

Additional information about NORTHWEST PERMANENTE, P.C.

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division
Incorporation Date: 1977-11-30
Company Identification Number: 12511713
Legal Registered Office Address: 500 NE MULTNOMAH ST STE 100

PORTLAND
United States of America (USA)
97232

More information about NORTHWEST PERMANENTE, P.C.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUPPLEMENTAL MEDICAL

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5152015-01-01HARRY STATHOS
5152014-01-01HARRY STATHOS
5152013-01-01HARRY STATHOS
5152012-01-01ANN STENZEL HARRY STATHOS2013-09-25
5152011-01-01ANN STENZEL HARRY STATHOS2012-10-01
5152010-01-01ANN STENZEL HARRY STATHOS2011-10-03
5152009-01-01ANN STENZEL RICHARD SHIMOMURA2010-09-23

Plan Statistics for SUPPLEMENTAL MEDICAL

401k plan membership statisitcs for SUPPLEMENTAL MEDICAL

Measure Date Value
2015: SUPPLEMENTAL MEDICAL 2015 401k membership
Total participants, beginning-of-year2015-01-011,477
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-010
2014: SUPPLEMENTAL MEDICAL 2014 401k membership
Total participants, beginning-of-year2014-01-011,439
Total number of active participants reported on line 7a of the Form 55002014-01-011,469
Number of retired or separated participants receiving benefits2014-01-018
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-011,477
2013: SUPPLEMENTAL MEDICAL 2013 401k membership
Total participants, beginning-of-year2013-01-011,720
Total number of active participants reported on line 7a of the Form 55002013-01-011,392
Number of retired or separated participants receiving benefits2013-01-01442
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-011,834
2012: SUPPLEMENTAL MEDICAL 2012 401k membership
Total participants, beginning-of-year2012-01-011,600
Total number of active participants reported on line 7a of the Form 55002012-01-011,720
Total of all active and inactive participants2012-01-011,720
2011: SUPPLEMENTAL MEDICAL 2011 401k membership
Total participants, beginning-of-year2011-01-011,539
Total number of active participants reported on line 7a of the Form 55002011-01-011,227
Number of retired or separated participants receiving benefits2011-01-01373
Total of all active and inactive participants2011-01-011,600
2010: SUPPLEMENTAL MEDICAL 2010 401k membership
Total participants, beginning-of-year2010-01-011,431
Total number of active participants reported on line 7a of the Form 55002010-01-011,203
Number of retired or separated participants receiving benefits2010-01-01336
Total of all active and inactive participants2010-01-011,539
2009: SUPPLEMENTAL MEDICAL 2009 401k membership
Total participants, beginning-of-year2009-01-011,385
Total number of active participants reported on line 7a of the Form 55002009-01-011,113
Number of retired or separated participants receiving benefits2009-01-01318
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-011,431

Form 5500 Responses for SUPPLEMENTAL MEDICAL

2015: SUPPLEMENTAL MEDICAL 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingYes
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: SUPPLEMENTAL MEDICAL 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: SUPPLEMENTAL MEDICAL 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: SUPPLEMENTAL MEDICAL 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: SUPPLEMENTAL MEDICAL 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: SUPPLEMENTAL MEDICAL 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: SUPPLEMENTAL MEDICAL 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MODA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10000120
Policy instance 1
Insurance contract or identification number10000120
Number of Individuals Covered5818
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $6,235
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,518,432
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,235
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS, LLC
MODA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10000120
Policy instance 1
Insurance contract or identification number10000120
Number of Individuals Covered5663
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,487
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,972
Insurance broker organization code?3
Insurance broker nameMERCER HEALTH & BENEFITS LLC
ODS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10000120M
Policy instance 1
Insurance contract or identification number10000120M
Number of Individuals Covered1834
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,350
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,249,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ODS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10000120M
Policy instance 1
Insurance contract or identification number10000120M
Number of Individuals Covered1720
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,981
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $967,474
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,981
Insurance broker organization code?3
Insurance broker nameBENEFIT PARTNERS
ODS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10000120M
Policy instance 1
Insurance contract or identification number10000120M
Number of Individuals Covered1600
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,733
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $926,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ODS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number10000120M
Policy instance 1
Insurance contract or identification number10000120M
Number of Individuals Covered1539
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,518
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $722,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,518
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameCLIFF BAILEY INSURANCE, INC.

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