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Plan Information

  • Plan Year01/01/2008 — 12/31/2008
  • Date of Plan06/01/1985
  • Net Assets as of 12/31/2008 $2,100,408
  • Plan Number2
  • Plan Type Single Employer
  • Is the plan collectively bargained? No
  • Did the plan file for an extension of time or the DFVC Program? No
  • Plan Funding ArrangementInsurance Trust
  • Plan Benefit ArrangementInsurance Trust

Participant Information as of 12/31/2008

  • Active (Eligible) Participants110
  • Retired or separated participants receiving benefits0
  • Other retired or separated participants entitled to future benefits15
  • Subtotal125
  • Deceased participants whose beneficiaries are receiving or are entitled to receive benefits0
  • Total125
  • Total number of participants as of 01/01/2008119
  • Number of participants with account balances123
  • Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested7
  • Number of participants required to be reported on Schedule SSA5


  • Total Benefit Payments$0
  • Corrective Distributions$0
  • Administrative Service Providers$0
  • Other Expenses$0
  • Total Expenses$0
  • Total Transfers$0

Sponsor Information

  • AddressPo Box 1121
  • CityRoseburg
  • StateOR
  • Zip97470-0254
  • Telephone(541) 672-2691
  • EIN93-0611783
  • Industry Code621420
  • Named AdministratorBruce Piper
  • Named Plan SponsorBruce Piper

Plan Administrator Information

  • Administrator NameSAME
  • Administrator EIN

Benefits Provided Under the Plan

Code Benefit Description
2E Profit-sharing A defined contribution plan that allows employer discretionary contributions. These plans often contain a 401(k) feature.
2F ERISA section 404(c) Plan This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
2G Total participant-directed account plan Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
2J Code section 401(k) feature A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
3E Prototype plan A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a separate funding medium (for example, a separate trust or custodial account) is established for the use of each adopting employer.

Questions and Answers

Question Answer Amount
During the plan year did the employer fail to transmit to the plan any participant contributions within the time period described in 29 CFT 2510.3-102? No
Were any loans by the plan or fixed income obligations due the plan in default as of the close of plan year or classified during the year as uncollectible? Disregard participant loans secured by participant's account balance. No
Were any leases to which the plan was a party in default or classified during the year as uncollectible? No
Were there any nonexempt transactions with any party-in-interest? No
Was this plan covered by a fidelity bond? Yes $800,000
Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by fraud or dishonesty? No
Did the plan hold any assets whose current value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan receive any noncash contributions whose value was neither readily determinable on an established market nor set by an independent third party appraiser? No
Did the plan at any time hold 20% or more of its assets in any single security, debt, mortgage, parcel of real estate, or partnership/joint venture interest? No $0
Are you claiming a waiver of the annual examination and report of an independent qualified public accountant (IQPA) under 29 CFR 2520.104-46? Yes
Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC? No


Income and Expense Statement

Income $-88,492
Contributions $0
Cash Contributions $339,885
Cash from Employers $167,382
Cash from Participants $160,277
Others (including rollovers) $12,226
Noncash Contributions $0
Other Income $-428,377
Expenses $160,496
Total Benefit Payments $160,496
Corrective Distributions $0
Certain deemed distributions of participant loans $0
Other Expenses $0
Net Income $-248,988
Transfers of Assets to (from) this Plan $0

Asset and Liability Statement

12/31/2008 12/31/2007 Change YOY
Total Assets $2,100,408 $2,349,396 -10.60%
Total Liabilities $0 $0 0.0%
Net Assets $2,100,408 $2,349,396 -10.60%

Specific Assets Statement

Held? Amount
Total Specific Assets No $131,953
Partnership/joint venture interests Yes $0
Employer Real Property Yes $0
Real Estate Yes $0
Employer Securities Yes $0
Participant Loans No $131,953
Loans (other than to participants) Yes $0
Tangible Personal Property Yes $0

Service Providers

Service Providers

There are no service providers listed for this plan.



Name of Investment Investment Manager Type of Investment Dollar Value
Separate Account A Standard Insurance Company DFE: Pooled Separate Account $1,128,933
Total $1,128,933

Insurance Information

Insurance Information

Insurance Carrier Summary Persons Covered
Standard Insurance Company 123
EIN 93-0242990
Industry Code 69019
Contract Number 801130
Contract Year 01/01/2008 — 12/31/2008
Value in General Account at Year End $651,319
Value in Separate Accounts at Year End $1,128,933
Insurance Fees and Commissions $6,967
Persons Receiving Commissions and Fees
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Thomas Clements 20585 SW 98th Ave Tualatin, OR 97062 Insurance Agent or Broker $6,967 $0
Allocated Funds
Type of Contract Unspecified
Basis of premium rates N/A
Premiums paid to carrier $0
Premiums due but unpaid at the end of the year $0
If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount $0
Specify the nature of the costs
Unallocated Funds
Type of Contract Deposit Administration
Balance at the end of the previous year $537,194
Additions $292,027
Contributions Deposited during the year $110,700
Dividends and credits $0
Interest credited during the year $18,704
Transferred from separate account $148,986
Other $13,637
Total of Balance and Additions $829,221
Deductions $177,902
Disbursed from fund to pay benefits or purchase annuities during the year $53,670
Administration charge made by carrier $5,492
Transferred to Separate Account $108,780
Other $9,960
Balance at the end of the current year $651,319