Form 5500 · Employee benefit plan · SAN JOSE, CA
GOODWILL INDUSTRIES OF SOUTHWEST OKLAHOM
The filing calls this plan GOODWILL INDUSTRIES OF SW OKLAHOMA HEALTH & WELFARE TRUST.
GOODWILL INDUSTRIES OF SOUTHWEST OKLAHOM of SAN JOSE, CA is a 129-participant construction employer whose group benefits are disclosed in its annual Form 5500 filing. Its broker of record is NORTH AMERICAN INS AGENCY LAWTON. Coverage is written through BLUE CROSS BLUSHIELD OF OKLAHOMA and 4 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 73-0675119 · plan 502 · plan year 2024, filed Aug 12, 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
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.
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 5 insured contracts covering health, dental, vision and life; the largest, with BLUE CROSS BLUSHIELD OF OKLAHOMA, covers 66 people.
The filing declares health, dental, vision and disability. Disability 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 $764,915, with $42,055 in disclosed broker commissions — about 5.5% 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.
NORTH AMERICAN INS AGENCY LAWTON is the broker of record on 1 of the 5 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| BLUE CROSS BLUSHIELD OF OKLAHOMA | Health, Dental | 66 | Jan 1, 2025 | $696,552 | $34,869 |
| DELTA DENTAL | Dental | 79 | Jan 1, 2025 | $29,611 | $2,961 |
| TELADOC HEALTH, INC. | — | 90 | Jan 1, 2025 | $16,484 | $2,473 |
| VSP | Vision | 93 | Jan 1, 2025 | $17,253 | $1,011 |
| DEARBORN LIFE INSURANCE COMPANY | Life | 129 | Jan 1, 2025 | $5,015 | $741 |
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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