MASAMI FOODS, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MASAMI FOODS, INC. BENEFIT PLAN
401k plan membership statisitcs for MASAMI FOODS, INC. BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: MASAMI FOODS, INC. BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 108 |
| Total of all active and inactive participants | 2022-01-01 | 108 |
| 2021: MASAMI FOODS, INC. BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 117 |
| Total of all active and inactive participants | 2021-01-01 | 117 |
| 2020: MASAMI FOODS, INC. BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 125 |
| Total of all active and inactive participants | 2020-01-01 | 125 |
| 2019: MASAMI FOODS, INC. BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 126 |
| Total of all active and inactive participants | 2019-01-01 | 126 |
| Total participants | 2019-01-01 | 126 |
| Number of participants with account balances | 2019-01-01 | 0 |
| 2018: MASAMI FOODS, INC. BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 133 |
| Total of all active and inactive participants | 2018-01-01 | 133 |
| Total participants | 2018-01-01 | 133 |
| 2017: MASAMI FOODS, INC. BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 138 |
| Total of all active and inactive participants | 2017-01-01 | 138 |
| Total participants | 2017-01-01 | 138 |
| 2016: MASAMI FOODS, INC. BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 135 |
| Total of all active and inactive participants | 2016-01-01 | 135 |
| Total participants | 2016-01-01 | 135 |
| 2015: MASAMI FOODS, INC. BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 135 |
| Total of all active and inactive participants | 2015-01-01 | 135 |
| Total participants | 2015-01-01 | 0 |
| 2014: MASAMI FOODS, INC. BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 142 |
| Total of all active and inactive participants | 2014-01-01 | 0 |
| Total participants | 2014-01-01 | 0 |
| 2013: MASAMI FOODS, INC. BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 151 |
| Total of all active and inactive participants | 2013-01-01 | 0 |
| Total participants | 2013-01-01 | 0 |
| 2012: MASAMI FOODS, INC. BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 141 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 151 |
| Total of all active and inactive participants | 2012-01-01 | 151 |
| Total participants | 2012-01-01 | 0 |
| 2011: MASAMI FOODS, INC. BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 137 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 141 |
| Total of all active and inactive participants | 2011-01-01 | 141 |
| Total participants | 2011-01-01 | 141 |
| 2010: MASAMI FOODS, INC. BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 137 |
| Total of all active and inactive participants | 2010-01-01 | 137 |
| Total participants | 2010-01-01 | 137 |
| 2009: MASAMI FOODS, INC. BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 136 |
| Total of all active and inactive participants | 2009-01-01 | 136 |
| Total participants | 2009-01-01 | 136 |
| 2008: MASAMI FOODS, INC. BENEFIT PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-01-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-01-01 | 129 |
| Total of all active and inactive participants | 2008-01-01 | 129 |
| Total participants | 2008-01-01 | 129 |
| 2007: MASAMI FOODS, INC. BENEFIT PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-01-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-01-01 | 105 |
| Total of all active and inactive participants | 2007-01-01 | 105 |
| Total participants | 2007-01-01 | 105 |
| 2022: MASAMI FOODS, INC. BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: MASAMI FOODS, INC. BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: MASAMI FOODS, INC. BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: MASAMI FOODS, INC. BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: MASAMI FOODS, INC. BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: MASAMI FOODS, INC. BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: MASAMI FOODS, INC. BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: MASAMI FOODS, INC. BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: MASAMI FOODS, INC. BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: MASAMI FOODS, INC. BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: MASAMI FOODS, INC. BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: MASAMI FOODS, INC. BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: MASAMI FOODS, INC. BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: MASAMI FOODS, INC. BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: MASAMI FOODS, INC. BENEFIT PLAN 2008 form 5500 responses |
|---|
| 2008-01-01 | Type of plan entity | Single employer plan |
| 2008-01-01 | Submission has been amended | No |
| 2008-01-01 | This submission is the final filing | No |
| 2008-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-01-01 | Plan is a collectively bargained plan | No |
| 2008-01-01 | Plan funding arrangement – Insurance | Yes |
| 2008-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: MASAMI FOODS, INC. BENEFIT PLAN 2007 form 5500 responses |
|---|
| 2007-01-01 | Type of plan entity | Single employer plan |
| 2007-01-01 | Submission has been amended | No |
| 2007-01-01 | This submission is the final filing | No |
| 2007-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-01-01 | Plan is a collectively bargained plan | No |
| 2007-01-01 | Plan funding arrangement – Insurance | Yes |
| 2007-01-01 | Plan benefit arrangement – Insurance | Yes |
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001893 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,096 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,096 | | Insurance broker organization code? | 3 |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001893 |
| Policy instance | 3 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $14,641 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,641 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $951 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,513 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $951 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 82-2723296 |
| Policy instance | 1 |
| Insurance contract or identification number | 82-2723296 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $5,886 | | Total amount of fees paid to insurance company | USD $105 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,277 | | Amount paid for insurance broker fees | 33 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 82-2723296 |
| Policy instance | 1 |
| Insurance contract or identification number | 82-2723296 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $4,261 | | Total amount of fees paid to insurance company | USD $126 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,337 | | Amount paid for insurance broker fees | 62 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,056 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,556 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,056 | | Insurance broker organization code? | 3 |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001893 |
| Policy instance | 3 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $14,632 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,632 | | Insurance broker organization code? | 3 |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001893 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $2,075 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,075 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 82-2723296 |
| Policy instance | 1 |
| Insurance contract or identification number | 82-2723296 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $6,186 | | Total amount of fees paid to insurance company | USD $170 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,215 | | Amount paid for insurance broker fees | 93 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,024 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,243 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,024 | | Insurance broker organization code? | 3 |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001893 |
| Policy instance | 3 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $15,747 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,747 | | Insurance broker organization code? | 3 |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001893 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,235 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,235 | | Insurance broker organization code? | 3 |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001893 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,324 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,324 | | Insurance broker organization code? | 3 |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001893 |
| Policy instance | 3 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $16,321 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,321 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,069 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,693 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,069 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 82-2723296 |
| Policy instance | 1 |
| Insurance contract or identification number | 82-2723296 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $5,133 | | Total amount of fees paid to insurance company | USD $279 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,748 | | Amount paid for insurance broker fees | 151 | | Insurance broker organization code? | 3 |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 82-2723296 |
| Policy instance | 1 |
| Insurance contract or identification number | 82-2723296 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $5,977 | | Total amount of fees paid to insurance company | USD $322 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,126 | | Amount paid for insurance broker fees | 184 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $932 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,321 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $932 | | Insurance broker organization code? | 3 |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001893 |
| Policy instance | 3 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $16,044 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,044 | | Insurance broker organization code? | 3 |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001893 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,415 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,415 | | Insurance broker organization code? | 3 |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001893 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,568 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,568 | | Insurance broker organization code? | 3 | | Insurance broker name | WHA INSURANCE AGENCY INC |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001893 |
| Policy instance | 3 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $16,671 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,671 | | Insurance broker organization code? | 3 | | Insurance broker name | WHA INSURANCE AGENCY INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $942 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,419 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $942 | | Insurance broker organization code? | 3 | | Insurance broker name | WHA INSURANCE AGENCY, INC. |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 82-2723296 |
| Policy instance | 1 |
| Insurance contract or identification number | 82-2723296 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $7,033 | | Total amount of fees paid to insurance company | USD $174 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,705 | | Amount paid for insurance broker fees | 99 | | Insurance broker organization code? | 3 | | Insurance broker name | MICHAEL A STACHOWIAK |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 58-0663085 |
| Policy instance | 1 |
| Insurance contract or identification number | 58-0663085 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,161 | | Total amount of fees paid to insurance company | USD $215 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,122 | | Amount paid for insurance broker fees | 91 | | Insurance broker organization code? | 3 | | Insurance broker name | RODERICK ALLEN BAIR |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $948 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,478 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $948 | | Insurance broker organization code? | 3 | | Insurance broker name | WHA INSURANCE AGENCY, INC. |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001893 |
| Policy instance | 3 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $15,600 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,600 | | Insurance broker organization code? | 3 | | Insurance broker name | WHA INSURANCE AGENCY INC |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $973 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,731 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $973 | | Insurance broker organization code? | 3 | | Insurance broker name | WHA INSURANCE AGENCY INC |
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| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 58-0663085 |
| Policy instance | 1 |
| Insurance contract or identification number | 58-0663085 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,904 | | Total amount of fees paid to insurance company | USD $140 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,762 | | Amount paid for insurance broker fees | 52 | | Insurance broker organization code? | 3 | | Insurance broker name | BRADLEY BAILEY |
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| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001893 |
| Policy instance | 3 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 326 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $15,600 | | Health Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid in cash? | Yes | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,600 | | Insurance broker organization code? | 3 | | Insurance broker name | WHA INSURANCE AGENCY, INC. |
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| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001893 |
| Policy instance | 5 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $11,814 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,814 | | Insurance broker organization code? | 3 | | Insurance broker name | WHA INSURANCE AGENCY, INC. |
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| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001893 |
| Policy instance | 1 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $2,562 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,801 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2562 | | Insurance broker organization code? | 3 | | Insurance broker name | WILSON-HEIRGOOD |
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| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 58-0663085 |
| Policy instance | 2 |
| Insurance contract or identification number | 58-0663085 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $6,201 | | Total amount of fees paid to insurance company | USD $153 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,826 | | Amount paid for insurance broker fees | 68 | | Insurance broker organization code? | 3 | | Insurance broker name | PHILLIP ALLAN PAGE |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 3 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $977 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,767 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $977 | | Insurance broker organization code? | 3 | | Insurance broker name | WHA INSURANCE AGENCY INC |
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| PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 ) |
| Policy contract number | G0016337 |
| Policy instance | 4 |
| Insurance contract or identification number | G0016337 | | Number of Individuals Covered | 142 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $14,343 | | Welfare Benefit Premiums Paid to Carrier | USD $708,124 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,343 | | Insurance broker organization code? | 3 | | Insurance broker name | GORDON GROSHONG |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,012 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,118 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,012 | | Insurance broker organization code? | 3 | | Insurance broker name | WHA INSURANCE AGENCY INC |
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| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 58-0663085 |
| Policy instance | 3 |
| Insurance contract or identification number | 58-0663085 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,087 | | Total amount of fees paid to insurance company | USD $64 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 8 | | Insurance broker name | KELLY HOWLAND |
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| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001893 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,628 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,866 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,628 | | Insurance broker organization code? | 3 | | Insurance broker name | WILSON-HEIRGOOD |
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| PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 ) |
| Policy contract number | G0016337 |
| Policy instance | 1 |
| Insurance contract or identification number | G0016337 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $12,919 | | Welfare Benefit Premiums Paid to Carrier | USD $657,204 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,919 | | Insurance broker organization code? | 3 | | Insurance broker name | GORDON GROSHONG |
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| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001893 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,525 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,953 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 58-0663085 |
| Policy instance | 3 |
| Insurance contract or identification number | 58-0663085 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $8,014 | | Total amount of fees paid to insurance company | USD $338 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $997 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,968 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 ) |
| Policy contract number | G0016337 |
| Policy instance | 1 |
| Insurance contract or identification number | G0016337 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $12,321 | | Welfare Benefit Premiums Paid to Carrier | USD $617,264 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001893 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001893 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,522 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,197 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | 58-0663085 |
| Policy instance | 3 |
| Insurance contract or identification number | 58-0663085 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $6,586 | | Total amount of fees paid to insurance company | USD $361 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PACIFICSOURCE HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 54976 ) |
| Policy contract number | G0016337 |
| Policy instance | 1 |
| Insurance contract or identification number | G0016337 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-05-31 | | Total amount of commissions paid to insurance broker | USD $5,166 | | Welfare Benefit Premiums Paid to Carrier | USD $252,064 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG086W8 |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG086W8 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,012 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,122 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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