401k Plan data: BICOASTAL MEDIA HEALTH AND WELFARE PLAN plan

BICOASTAL MEDIA HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	BICOASTAL MEDIA HEALTH AND WELFARE PLAN
Plan identification number	501

BICOASTAL MEDIA HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision 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. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

BICOASTAL MEDIA has sponsored the creation of one or more 401k plans.

Company Name: BICOASTAL MEDIA

Employer identification number (EIN): 943304942

NAIC Classification: 515100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BICOASTAL MEDIA HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2020-09-01
501 2019-09-01
501 2012-09-01 ANGELA MONTOYA
501 2011-09-01 ANGELA MONTOYA ANGELA MONTOYA 2013-03-27

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2020-09-01
501	2019-09-01
501	2012-09-01	ANGELA MONTOYA
501	2011-09-01	ANGELA MONTOYA	ANGELA MONTOYA	2013-03-27

Plan Statistics for BICOASTAL MEDIA HEALTH AND WELFARE PLAN

401k plan membership statisitcs for BICOASTAL MEDIA HEALTH AND WELFARE PLAN

Measure Date Value
2020: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-09-01 107
Total number of active participants reported on line 7a of the Form 5500 2020-09-01 93
Number of retired or separated participants receiving benefits 2020-09-01 1
Number of other retired or separated participants entitled to future benefits 2020-09-01 0
Total of all active and inactive participants 2020-09-01 94
2019: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-09-01 118
Total number of active participants reported on line 7a of the Form 5500 2019-09-01 104
Number of retired or separated participants receiving benefits 2019-09-01 3
Number of other retired or separated participants entitled to future benefits 2019-09-01 0
Total of all active and inactive participants 2019-09-01 107
2012: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-09-01 131
Total number of active participants reported on line 7a of the Form 5500 2012-09-01 85
Number of retired or separated participants receiving benefits 2012-09-01 0
Number of other retired or separated participants entitled to future benefits 2012-09-01 0
Total of all active and inactive participants 2012-09-01 85
2011: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-09-01 99
Total number of active participants reported on line 7a of the Form 5500 2011-09-01 143
Number of retired or separated participants receiving benefits 2011-09-01 0
Number of other retired or separated participants entitled to future benefits 2011-09-01 1
Total of all active and inactive participants 2011-09-01 144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-09-01 0
Total participants 2011-09-01 144
Number of participants with account balances 2011-09-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-09-01 0

Measure	Date	Value
2020: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-09-01	107
Total number of active participants reported on line 7a of the Form 5500	2020-09-01	93
Number of retired or separated participants receiving benefits	2020-09-01	1
Number of other retired or separated participants entitled to future benefits	2020-09-01	0
Total of all active and inactive participants	2020-09-01	94
2019: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-09-01	118
Total number of active participants reported on line 7a of the Form 5500	2019-09-01	104
Number of retired or separated participants receiving benefits	2019-09-01	3
Number of other retired or separated participants entitled to future benefits	2019-09-01	0
Total of all active and inactive participants	2019-09-01	107
2012: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-09-01	131
Total number of active participants reported on line 7a of the Form 5500	2012-09-01	85
Number of retired or separated participants receiving benefits	2012-09-01	0
Number of other retired or separated participants entitled to future benefits	2012-09-01	0
Total of all active and inactive participants	2012-09-01	85
2011: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-09-01	99
Total number of active participants reported on line 7a of the Form 5500	2011-09-01	143
Number of retired or separated participants receiving benefits	2011-09-01	0
Number of other retired or separated participants entitled to future benefits	2011-09-01	1
Total of all active and inactive participants	2011-09-01	144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-09-01	0
Total participants	2011-09-01	144
Number of participants with account balances	2011-09-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-09-01	0

Form 5500 Responses for BICOASTAL MEDIA HEALTH AND WELFARE PLAN

2020: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-09-01	Type of plan entity	Single employer plan
2020-09-01	Submission has been amended	No
2020-09-01	This submission is the final filing	No
2020-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-09-01	Plan is a collectively bargained plan	No
2020-09-01	Plan funding arrangement – Insurance	Yes
2020-09-01	Plan benefit arrangement – Insurance	Yes
2019: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-09-01	Type of plan entity	Single employer plan
2019-09-01	Submission has been amended	No
2019-09-01	This submission is the final filing	No
2019-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-09-01	Plan is a collectively bargained plan	No
2019-09-01	Plan funding arrangement – Insurance	Yes
2019-09-01	Plan benefit arrangement – Insurance	Yes
2012: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-09-01	Type of plan entity	Single employer plan
2012-09-01	Submission has been amended	No
2012-09-01	This submission is the final filing	No
2012-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-09-01	Plan is a collectively bargained plan	No
2012-09-01	Plan funding arrangement – Insurance	Yes
2012-09-01	Plan benefit arrangement – Insurance	Yes
2011: BICOASTAL MEDIA HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-09-01	Type of plan entity	Single employer plan
2011-09-01	First time form 5500 has been submitted	Yes
2011-09-01	Submission has been amended	No
2011-09-01	This submission is the final filing	No
2011-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-09-01	Plan is a collectively bargained plan	No
2011-09-01	Plan funding arrangement – Insurance	Yes
2011-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	10010326
Policy instance	1
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	30003426
Policy instance	2
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	GR00004716
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	1025345
Policy instance	4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	40000100021527
Policy instance	5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	40000100021527
Policy instance	1
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	GR00004716
Policy instance	2
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	10010326
Policy instance	3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	30003426
Policy instance	4

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Company Name:	BICOASTAL MEDIA
Employer identification number (EIN):	943304942
NAIC Classification:	515100