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| Plan Name | SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | SPECIAL SERVICE FOR GROUPS, INC. |
| Employer identification number (EIN): | 951716914 |
| NAIC Classification: | 624200 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2010-05-01 | HERBERT HATANAKA | 2019-09-30 | ||
| 504 | 2009-05-01 | HERBERT HATANAKA | 2019-09-30 | ||
| 504 | 2008-05-01 | HERBERT HATANAKA | 2019-09-30 | ||
| 504 | 2007-05-01 | HERBERT HATANAKA | 2019-09-30 | ||
| 504 | 2006-05-01 | HERBERT HATANAKA | 2019-09-30 | ||
| 504 | 2005-05-01 | HERBERT HATANAKA | 2019-09-30 | ||
| 504 | 2004-05-01 | HERBERT HATANAKA | 2019-09-30 | ||
| 504 | 2003-05-01 | HERBERT HATANAKA | 2019-09-30 | ||
| 504 | 2002-05-01 | HERBERT HATANAKA | 2019-09-30 | ||
| 504 | 2001-05-01 | HERBERT HATANAKA | 2019-09-30 | ||
| 504 | 2000-05-01 | HERBERT HATANAKA | 2019-09-30 | ||
| 504 | 1999-05-01 | HERBERT HATANAKA | 2019-09-30 |
| 2010: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 2010 form 5500 responses | ||
|---|---|---|
| 2010-05-01 | Type of plan entity | Single employer plan |
| 2010-05-01 | This submission is the final filing | Yes |
| 2010-05-01 | Plan funding arrangement – Insurance | Yes |
| 2010-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 2009 form 5500 responses | ||
| 2009-05-01 | Type of plan entity | Single employer plan |
| 2009-05-01 | Plan funding arrangement – Insurance | Yes |
| 2009-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 2008 form 5500 responses | ||
| 2008-05-01 | Type of plan entity | Single employer plan |
| 2008-05-01 | Plan funding arrangement – Insurance | Yes |
| 2008-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 2007 form 5500 responses | ||
| 2007-05-01 | Type of plan entity | Single employer plan |
| 2007-05-01 | Plan funding arrangement – Insurance | Yes |
| 2007-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 2006 form 5500 responses | ||
| 2006-05-01 | Type of plan entity | Single employer plan |
| 2006-05-01 | Plan funding arrangement – Insurance | Yes |
| 2006-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 2005 form 5500 responses | ||
| 2005-05-01 | Type of plan entity | Single employer plan |
| 2005-05-01 | Plan funding arrangement – Insurance | Yes |
| 2005-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 2004 form 5500 responses | ||
| 2004-05-01 | Type of plan entity | Single employer plan |
| 2004-05-01 | Plan funding arrangement – Insurance | Yes |
| 2004-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 2003 form 5500 responses | ||
| 2003-05-01 | Type of plan entity | Single employer plan |
| 2003-05-01 | Plan funding arrangement – Insurance | Yes |
| 2003-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2002: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 2002 form 5500 responses | ||
| 2002-05-01 | Type of plan entity | Single employer plan |
| 2002-05-01 | Plan funding arrangement – Insurance | Yes |
| 2002-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2001: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 2001 form 5500 responses | ||
| 2001-05-01 | Type of plan entity | Single employer plan |
| 2001-05-01 | Plan funding arrangement – Insurance | Yes |
| 2001-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2000: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 2000 form 5500 responses | ||
| 2000-05-01 | Type of plan entity | Single employer plan |
| 2000-05-01 | Plan funding arrangement – Insurance | Yes |
| 2000-05-01 | Plan benefit arrangement – Insurance | Yes |
| 1999: SPECIAL SERVICE FOR GROUPS, INC. MEDICAL PLAN 1999 form 5500 responses | ||
| 1999-05-01 | Type of plan entity | Single employer plan |
| 1999-05-01 | First time form 5500 has been submitted | Yes |
| 1999-05-01 | Plan funding arrangement – Insurance | Yes |
| 1999-05-01 | Plan benefit arrangement – Insurance | Yes |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | H54319 / 944169 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | H54319 / 944169 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | H54319 / 944169 |
| Policy instance | 1 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | H54319 / 944169 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | H54319 / 944169 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| PACIFIC CARE (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 00 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 00 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 00 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 00 |
| Policy instance | 1 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 00 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 00 |
| Policy instance | 1 |
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 127759 |
| Policy instance | 2 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) | |
| Policy contract number | 00 |
| Policy instance | 1 |
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