Form 5500 · Employee benefit plan · CORVALLIS, OR
CITIZENS BANK
The filing calls this plan CITIZENS BANK HEALTH & WELFARE BENEFIT PLAN.
CITIZENS BANK of CORVALLIS, OR is a 185-participant finance and insurance employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is MJI, INC.. Coverage is written through OREGON DENTAL SERVICE and 3 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 93-0462799 · plan 501 · plan year 2025, filed Jun 17, 2026
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How this plan is funded
Funding not settled by the filing
The filing does not report enough to settle how this plan pays for benefits.
Benefits declared on this filing
One contract on this filing does not say which benefits it covers, so a line above may be insured by it.
Also declared: death benefits, other welfare.
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 4 insured contracts covering dental, vision, life and disability; the largest, with OREGON DENTAL SERVICE, covers 328 people.
The filing declares dental, vision, life, disability and health. Health appears with no insured contract on Schedule A. That coverage may be self-funded, placed with a carrier that is not on this filing, or written on the contract here that does not say what it covers.
Reported premium across the insured contracts is $318,430, with $27,942 in disclosed broker commissions — about 8.8% of premium.
The most recent policy period ended in December, and the plan year ends December 31. Group contracts typically renew on that annual cycle.
MJI, INC. is the broker of record on 3 of the 4 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| METROPOLITAN LIFE INSURANCE COMPANY | Life, Disability | 335 | Jan 1, 2026 | $103,340 | $21,145 |
| OREGON DENTAL SERVICE | Dental | 328 | Jan 1, 2026 | $181,164 | $5,436 |
| VISION SERVICE PLAN | Vision | 154 | Jan 1, 2026 | $28,490 | $1,361 |
| CANOPY | — | 184 | Jan 1, 2026 | $5,436 | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. We publish company names only.
Other plans filed by this employer
How this plan compares
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