Form 5500 · Employee benefit plan · EUGENE, OR
MOUNTAIN ROSE HERBS, INC.
The filing calls this plan MOUNTAIN ROSE HEALTH AND WELFARE PLAN.
Public Form 5500 records show how MOUNTAIN ROSE HERBS, INC. of EUGENE, OR, a wholesale trade employer, structures its employee benefits. Its broker of record is HUB INTERNATIONAL NORTHWEST, LLC. Coverage is written through PACIFICSOURCE HEALTH PLANS and 2 other carriers. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 90-0004806 · plan 501 · plan year 2025, filed Nov 20, 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
Also declared: 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 3 insured contracts covering health, dental, vision and life; the largest, with PACIFICSOURCE HEALTH PLANS, covers 173 people.
Reported premium across the insured contracts is $1,309,183, with $50,702 in disclosed broker commissions — about 3.9% of premium.
The most recent policy period ended in May, and the plan year ends May 31. Group contracts typically renew on that annual cycle.
HUB INTERNATIONAL NORTHWEST, LLC is the broker of record on 2 of the 3 contracts; the rest name a different broker or none.
3 carriers appear on the filing, including PACIFICSOURCE HEALTH PLANS, THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA and CASCADE HEALTH. PACIFICSOURCE HEALTH PLANS writes the largest contract by premium.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| PACIFICSOURCE HEALTH PLANS | Health | 173 | Jun 1, 2025 | $1,187,471 | $40,835 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA | Dental, Vision, Life | 179 | Jun 1, 2025 | $117,530 | $9,867 |
| CASCADE HEALTH | — | 195 | Jun 1, 2025 | $4,182 | $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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