Form 5500 · Employee benefit plan · TUALATIN, OR
FUJIMI CORPORATION
The filing calls this plan FUJIMI CORPORATION WELFARE BENEFIT PLAN.
FUJIMI CORPORATION of TUALATIN, OR files a Form 5500 with the U.S. Department of Labor disclosing its employee benefit plan. Its broker of record is USI INSURANCE SERVICES, LLC. Coverage is written through HEALTH NET and 3 other carriers. The plan's most recent policy period ended in September.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 93-0982049 · plan 501 · plan year 2025, filed Mar 23, 2026
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How this plan is funded
Fully insured as reported
The filing reports medical coverage through an insurance contract on Schedule A, and no money paid for benefits by the plan itself.
Benefits declared on this filing
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.
Where a line has more than one insured contract, the carrier and the covered figure are the largest contract's by premium. The contracts are not added up: a pharmacy carve-out and the medical carrier beside it cover the same people.
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 health, dental, vision, life and disability; the largest, with HEALTH NET, covers 72 people.
Reported premium across the insured contracts is $2,663,369, with $89,281 in disclosed broker commissions — about 3.4% of premium.
The most recent policy period ended in September, and the plan year ends September 30. Group contracts typically renew on that annual cycle.
USI INSURANCE SERVICES, LLC is the broker of record on 3 of the 4 contracts; the rest name a different broker or none.
4 carriers appear on the filing, including HEALTH NET, KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST, OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON and PRUDENTIAL INSURANCE COMPANY OF AMERICA. HEALTH NET writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| HEALTH NET | Health, Vision | 72 | Oct 1, 2025 | $1,811,879 | $55,253 |
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | Health, Vision | 77 | Oct 1, 2025 | $626,163 | $18,691 |
| PRUDENTIAL INSURANCE COMPANY OF AMERICA | Life, Disability | 120 | Oct 1, 2025 | $75,151 | $10,828 |
| OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | Dental | 252 | Oct 1, 2025 | $150,176 | $4,509 |
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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