Form 5500 · Employee benefit plan · WOODBURN, OR
GEM EQUIPMENT OF OREGON INC.
The filing calls this plan GEM EQUIPMENT OF OREGON INC. HEALTH AND WELFARE BENEFIT PLAN.
GEM EQUIPMENT OF OREGON INC. of WOODBURN, OR spreads its employee benefits across 3 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is WHA INSURANCE AGENCY INC. Coverage is written through KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 93-0572107 · plan 501 · plan year 2024, filed Jul 18, 2025
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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
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 KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST, covers 208 people.
Reported premium across the insured contracts is $1,287,161, with $46,174 in disclosed broker commissions — about 3.6% 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.
WHA INSURANCE AGENCY INC is the broker of record on all 4 contracts.
3 carriers appear on the filing, including KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST, PRINCIPAL LIFE INSURANCE COMPANY and OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON. KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST | Health | 208 | Jan 1, 2025 | $1,065,272 | $30,616 |
| PRINCIPAL LIFE INSURANCE COMPANY | Vision, Life, Disability | 260 | Jan 1, 2025 | $113,894 | $12,339 |
| OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | Dental | 119 | Jan 1, 2025 | $54,079 | $1,620 |
| OREGON DENTAL SERVICE DBA DELTA DENTAL PLAN OF OREGON | Dental | 118 | Jan 1, 2025 | $53,916 | $1,599 |
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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