Form 5500 · Employee benefit plan · PORTLAND, OR
TIRE FACTORY INC
The filing calls this plan TIRE FACTORY HEALTH AND WELFARE PLAN.
TIRE FACTORY INC of PORTLAND, OR spreads its employee benefits across 3 insurance carriers, according to its Form 5500 Schedule A. Its broker of record is HUB INTERNATIONAL NORTHWEST LLC. Coverage is written through UNITED OF OMAHA LIFE INSURANCE COMPANY and 2 other carriers. The plan's most recent policy period ended in December.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 46-4237082 · plan 501 · plan year 2025, filed Jul 27, 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
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.
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 dental, vision, life and disability; the largest, with UNITED OF OMAHA LIFE INSURANCE COMPANY, covers 109 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, or placed with a carrier that is not on this filing.
Reported premium across the insured contracts is $147,667, with $11,262 in disclosed broker commissions — about 7.6% 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.
HUB INTERNATIONAL NORTHWEST LLC is the broker of record on 2 of the 3 contracts; the rest name a different broker or none.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| RELIANCE STANDARD LIFE INSURANCE COMPANY | Life, Disability | 149 | Jan 1, 2026 | $66,584 | $6,659 |
| UNITED OF OMAHA LIFE INSURANCE COMPANY | Dental | 109 | Jan 1, 2026 | $69,797 | $3,490 |
| METROPOLITAN LIFE INSURANCE COMPANY | Vision | 154 | Jan 1, 2026 | $11,286 | $1,113 |
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.
Reported to OSHA
Reported to OSHA for 2025: 147 employees, 5 recordable cases, 733 days away from work.
Source: OSHA Injury Tracking Application establishment data, 2025.
Other plans filed by this employer
How this plan compares
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