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RETIREE GROUP MEDICAL BENEFITS PLAN 401k Plan overview

Plan NameRETIREE GROUP MEDICAL BENEFITS PLAN
Plan identification number 513

RETIREE GROUP MEDICAL BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Other welfare benefit cover

401k Sponsoring company profile

THE RAND CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:THE RAND CORPORATION
Employer identification number (EIN):951958142
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Additional information about THE RAND CORPORATION

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 1994-12-01
Company Identification Number: 19941123613
Legal Registered Office Address: 5550 S FT APACHE RD STE 102

LAS VEGAS
United States of America (USA)
89148

More information about THE RAND CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RETIREE GROUP MEDICAL BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5132022-01-01
5132021-01-01
5132020-01-01
5132020-01-01
5132019-01-01
5132019-01-01
5132018-01-01
5132017-01-01BRADLEY BEVERAGE
5132016-01-01BRADLEY BEVERAGE
5132015-01-01TRINITY EYRE
5132014-01-01TRINITY EYRE
5132014-01-01TRINITY EYRE
5132013-01-01MICHAEL J. GALLAGHER
5132012-01-01MICHAEL J. GALLAGHER
5132011-01-01MICHAEL GALLAGHER
5132009-01-01MICHAEL GALLAGHER
5132008-10-01

Plan Statistics for RETIREE GROUP MEDICAL BENEFITS PLAN

401k plan membership statisitcs for RETIREE GROUP MEDICAL BENEFITS PLAN

Measure Date Value
2022: RETIREE GROUP MEDICAL BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01362
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-01365
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01365
2021: RETIREE GROUP MEDICAL BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01351
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-01362
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01362
2020: RETIREE GROUP MEDICAL BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01295
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-01351
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01351
2019: RETIREE GROUP MEDICAL BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01294
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-01295
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01295
2018: RETIREE GROUP MEDICAL BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01270
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-01294
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01294
2017: RETIREE GROUP MEDICAL BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01291
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-01270
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01270
2016: RETIREE GROUP MEDICAL BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01293
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-01291
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01291
2015: RETIREE GROUP MEDICAL BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01300
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-01293
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01293
2014: RETIREE GROUP MEDICAL BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01310
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-01300
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01300
2013: RETIREE GROUP MEDICAL BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01295
Total number of active participants reported on line 7a of the Form 55002013-01-010
Number of retired or separated participants receiving benefits2013-01-01310
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01310
2012: RETIREE GROUP MEDICAL BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01282
Total number of active participants reported on line 7a of the Form 55002012-01-010
Number of retired or separated participants receiving benefits2012-01-01295
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01295
2011: RETIREE GROUP MEDICAL BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01280
Total number of active participants reported on line 7a of the Form 55002011-01-010
Number of retired or separated participants receiving benefits2011-01-01282
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01282
2009: RETIREE GROUP MEDICAL BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01178
Total number of active participants reported on line 7a of the Form 55002009-01-01174
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01174

Financial Data on RETIREE GROUP MEDICAL BENEFITS PLAN

Measure Date Value
2022 : RETIREE GROUP MEDICAL BENEFITS PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$61,259
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$97,908
Total income from all sources (including contributions)2022-12-31$-3,411,632
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$1,294,645
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,233,295
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$214,748
Value of total assets at end of year2022-12-31$24,007,783
Value of total assets at beginning of year2022-12-31$28,750,709
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$61,350
Total interest from all sources2022-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$513,701
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$513,701
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$214,748
Participant contributions at end of year2022-12-31$400,443
Participant contributions at beginning of year2022-12-31$17,404
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$57,487
Liabilities. Value of operating payables at end of year2022-12-31$61,259
Liabilities. Value of operating payables at beginning of year2022-12-31$40,421
Total non interest bearing cash at end of year2022-12-31$492,723
Total non interest bearing cash at beginning of year2022-12-31$344,624
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-4,706,277
Value of net assets at end of year (total assets less liabilities)2022-12-31$23,946,524
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$28,652,801
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$61,350
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$23,114,617
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$28,388,681
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$157,270
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-4,140,081
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,076,025
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2022-12-31951777440
2021 : RETIREE GROUP MEDICAL BENEFITS PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$97,908
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$35,323
Total income from all sources (including contributions)2021-12-31$3,200,172
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$1,339,042
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,282,712
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$214,409
Value of total assets at end of year2021-12-31$28,750,709
Value of total assets at beginning of year2021-12-31$26,826,994
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$56,330
Total interest from all sources2021-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$739,286
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$739,286
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$214,409
Participant contributions at end of year2021-12-31$17,404
Participant contributions at beginning of year2021-12-31$21,900
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$57,487
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$0
Liabilities. Value of operating payables at end of year2021-12-31$40,421
Liabilities. Value of operating payables at beginning of year2021-12-31$35,323
Total non interest bearing cash at end of year2021-12-31$344,624
Total non interest bearing cash at beginning of year2021-12-31$501,574
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,861,130
Value of net assets at end of year (total assets less liabilities)2021-12-31$28,652,801
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$26,791,671
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$56,330
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$28,388,681
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$26,303,520
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$207,012
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$2,246,477
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Employer contributions (assets) at end of year2021-12-31$0
Employer contributions (assets) at beginning of year2021-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,075,700
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2021-12-31951777440
2020 : RETIREE GROUP MEDICAL BENEFITS PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$35,323
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$39,730
Total income from all sources (including contributions)2020-12-31$3,126,596
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$1,218,845
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$1,157,225
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$215,041
Value of total assets at end of year2020-12-31$26,826,994
Value of total assets at beginning of year2020-12-31$24,923,650
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$61,620
Total interest from all sources2020-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$488,473
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$488,473
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$215,041
Participant contributions at end of year2020-12-31$21,900
Participant contributions at beginning of year2020-12-31$14,992
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$0
Liabilities. Value of operating payables at end of year2020-12-31$35,323
Liabilities. Value of operating payables at beginning of year2020-12-31$39,730
Total non interest bearing cash at end of year2020-12-31$501,574
Total non interest bearing cash at beginning of year2020-12-31$285,368
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$1,907,751
Value of net assets at end of year (total assets less liabilities)2020-12-31$26,791,671
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$24,883,920
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$61,620
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$26,303,520
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$24,623,290
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$185,598
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$2,423,082
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$0
Employer contributions (assets) at end of year2020-12-31$0
Employer contributions (assets) at beginning of year2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$971,627
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2020-12-31951777440
2019 : RETIREE GROUP MEDICAL BENEFITS PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$39,730
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$39,730
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$-76
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$-76
Total income from all sources (including contributions)2019-12-31$4,532,195
Total income from all sources (including contributions)2019-12-31$4,532,195
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$958,415
Total of all expenses incurred2019-12-31$958,415
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$896,583
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$896,583
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$478,559
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$478,559
Value of total assets at end of year2019-12-31$24,923,650
Value of total assets at end of year2019-12-31$24,923,650
Value of total assets at beginning of year2019-12-31$21,310,064
Value of total assets at beginning of year2019-12-31$21,310,064
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$61,832
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$61,832
Total interest from all sources2019-12-31$0
Total interest from all sources2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$631,323
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$631,323
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$631,323
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$631,323
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,000,000
Value of fidelity bond cover2019-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$165,093
Contributions received from participants2019-12-31$165,093
Participant contributions at end of year2019-12-31$14,992
Participant contributions at end of year2019-12-31$14,992
Participant contributions at beginning of year2019-12-31$27,680
Participant contributions at beginning of year2019-12-31$27,680
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other income not declared elsewhere2019-12-31$658
Liabilities. Value of operating payables at end of year2019-12-31$39,730
Liabilities. Value of operating payables at end of year2019-12-31$39,730
Liabilities. Value of operating payables at beginning of year2019-12-31$-76
Liabilities. Value of operating payables at beginning of year2019-12-31$-76
Total non interest bearing cash at end of year2019-12-31$285,368
Total non interest bearing cash at end of year2019-12-31$285,368
Total non interest bearing cash at beginning of year2019-12-31$286,799
Total non interest bearing cash at beginning of year2019-12-31$286,799
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$3,573,780
Value of net income/loss2019-12-31$3,573,780
Value of net assets at end of year (total assets less liabilities)2019-12-31$24,883,920
Value of net assets at end of year (total assets less liabilities)2019-12-31$24,883,920
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$21,310,140
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$21,310,140
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$61,832
Investment advisory and management fees2019-12-31$61,832
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$24,623,290
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$24,623,290
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$20,891,096
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$20,891,096
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$225,239
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$225,239
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$3,422,313
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$3,422,313
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$313,466
Contributions received in cash from employer2019-12-31$313,466
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$104,489
Employer contributions (assets) at beginning of year2019-12-31$104,489
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$671,344
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$671,344
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31GREEN HASSON & JANKS LLP
Accountancy firm name2019-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2019-12-31951777440
Accountancy firm EIN2019-12-31951777440
2018 : RETIREE GROUP MEDICAL BENEFITS PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$-76
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$2,657
Total income from all sources (including contributions)2018-12-31$-918,984
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$788,809
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$748,788
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$668,151
Value of total assets at end of year2018-12-31$21,310,064
Value of total assets at beginning of year2018-12-31$23,020,590
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$40,021
Total interest from all sources2018-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$686,715
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$686,715
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$192,984
Participant contributions at end of year2018-12-31$27,680
Participant contributions at beginning of year2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$438
Liabilities. Value of operating payables at end of year2018-12-31$-76
Liabilities. Value of operating payables at beginning of year2018-12-31$2,219
Total non interest bearing cash at end of year2018-12-31$286,799
Total non interest bearing cash at beginning of year2018-12-31$248,810
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-1,707,793
Value of net assets at end of year (total assets less liabilities)2018-12-31$21,310,140
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$23,017,933
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$40,021
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$20,891,096
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$22,648,220
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$139,445
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-2,273,850
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$475,167
Employer contributions (assets) at end of year2018-12-31$104,489
Employer contributions (assets) at beginning of year2018-12-31$123,560
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$609,343
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2018-12-31951777440
2017 : RETIREE GROUP MEDICAL BENEFITS PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$2,657
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$487,730
Total income from all sources (including contributions)2017-12-31$4,865,416
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$745,309
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$712,273
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$897,666
Value of total assets at end of year2017-12-31$23,020,590
Value of total assets at beginning of year2017-12-31$19,385,556
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$33,036
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$578,763
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$578,763
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$104,335
Participant contributions at end of year2017-12-31$0
Participant contributions at beginning of year2017-12-31$58,285
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$438
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$453,849
Liabilities. Value of operating payables at end of year2017-12-31$2,219
Liabilities. Value of operating payables at beginning of year2017-12-31$33,881
Total non interest bearing cash at end of year2017-12-31$248,810
Total non interest bearing cash at beginning of year2017-12-31$205,696
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$4,120,107
Value of net assets at end of year (total assets less liabilities)2017-12-31$23,017,933
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$18,897,826
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$33,036
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$22,648,220
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$18,898,318
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$159,012
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$3,388,987
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$793,331
Employer contributions (assets) at end of year2017-12-31$123,560
Employer contributions (assets) at beginning of year2017-12-31$223,257
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$553,261
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2017-12-31951777440
2016 : RETIREE GROUP MEDICAL BENEFITS PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$487,730
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$2,747
Total income from all sources (including contributions)2016-12-31$2,974,075
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$1,200,398
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$1,175,028
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,622,880
Value of total assets at end of year2016-12-31$19,385,556
Value of total assets at beginning of year2016-12-31$17,126,896
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$25,370
Total interest from all sources2016-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$479,614
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$479,614
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$538,267
Participant contributions at end of year2016-12-31$58,285
Participant contributions at beginning of year2016-12-31$19,388
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$453,849
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$0
Liabilities. Value of operating payables at end of year2016-12-31$33,881
Liabilities. Value of operating payables at beginning of year2016-12-31$2,747
Total non interest bearing cash at end of year2016-12-31$205,696
Total non interest bearing cash at beginning of year2016-12-31$162,588
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$1,773,677
Value of net assets at end of year (total assets less liabilities)2016-12-31$18,897,826
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$17,124,149
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$25,370
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$18,898,318
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$16,657,801
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$445,140
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$871,581
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$1,084,613
Employer contributions (assets) at end of year2016-12-31$223,257
Employer contributions (assets) at beginning of year2016-12-31$287,119
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$729,888
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2016-12-31951777440
2015 : RETIREE GROUP MEDICAL BENEFITS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$2,747
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$2,107
Total income from all sources (including contributions)2015-12-31$1,276,413
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$1,147,347
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$1,119,444
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,515,635
Value of total assets at end of year2015-12-31$17,126,896
Value of total assets at beginning of year2015-12-31$16,997,190
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$27,903
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$615,071
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$615,071
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$510,298
Participant contributions at end of year2015-12-31$19,388
Participant contributions at beginning of year2015-12-31$15,065
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$0
Liabilities. Value of operating payables at end of year2015-12-31$2,747
Liabilities. Value of operating payables at beginning of year2015-12-31$2,107
Total non interest bearing cash at end of year2015-12-31$162,588
Total non interest bearing cash at beginning of year2015-12-31$118,606
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$129,066
Value of net assets at end of year (total assets less liabilities)2015-12-31$17,124,149
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$16,995,083
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$27,903
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$16,657,801
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$16,624,113
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$515,284
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-854,293
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$1,005,337
Employer contributions (assets) at end of year2015-12-31$287,119
Employer contributions (assets) at beginning of year2015-12-31$239,406
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$604,160
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2015-12-31951777440
2014 : RETIREE GROUP MEDICAL BENEFITS PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$2,107
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$2,107
Total income from all sources (including contributions)2014-12-31$2,125,471
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$1,197,053
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,180,953
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$1,591,078
Value of total assets at end of year2014-12-31$16,997,190
Value of total assets at beginning of year2014-12-31$16,068,772
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$16,100
Total interest from all sources2014-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$550,260
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$550,260
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$572,839
Participant contributions at end of year2014-12-31$15,065
Participant contributions at beginning of year2014-12-31$12,586
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$0
Liabilities. Value of operating payables at end of year2014-12-31$2,107
Liabilities. Value of operating payables at beginning of year2014-12-31$2,107
Total non interest bearing cash at end of year2014-12-31$118,606
Total non interest bearing cash at beginning of year2014-12-31$563,981
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$928,418
Value of net assets at end of year (total assets less liabilities)2014-12-31$16,995,083
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$16,066,665
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$16,100
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$16,624,113
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$15,232,594
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$545,495
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$-15,867
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$1,018,239
Employer contributions (assets) at end of year2014-12-31$239,406
Employer contributions (assets) at beginning of year2014-12-31$259,611
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$635,458
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2014-12-31951777440
2013 : RETIREE GROUP MEDICAL BENEFITS PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$2,107
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$6,200
Total income from all sources (including contributions)2013-12-31$3,999,805
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$1,113,670
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$1,099,876
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,739,260
Value of total assets at end of year2013-12-31$16,068,772
Value of total assets at beginning of year2013-12-31$13,186,730
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$13,794
Total interest from all sources2013-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$382,571
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$382,571
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$594,330
Participant contributions at end of year2013-12-31$12,586
Participant contributions at beginning of year2013-12-31$4,004
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$1,614,632
Liabilities. Value of operating payables at end of year2013-12-31$2,107
Liabilities. Value of operating payables at beginning of year2013-12-31$6,200
Total non interest bearing cash at end of year2013-12-31$563,981
Total non interest bearing cash at beginning of year2013-12-31$121,744
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$2,886,135
Value of net assets at end of year (total assets less liabilities)2013-12-31$16,066,665
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$13,180,530
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Investment advisory and management fees2013-12-31$13,794
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$15,232,594
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$11,151,244
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$509,907
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$1,877,974
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$1,144,930
Employer contributions (assets) at end of year2013-12-31$259,611
Employer contributions (assets) at beginning of year2013-12-31$295,106
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$589,969
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2013-12-31951777440
2012 : RETIREE GROUP MEDICAL BENEFITS PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$6,200
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$2,107
Total income from all sources (including contributions)2012-12-31$3,533,529
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$1,123,542
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$1,111,004
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$2,147,061
Value of total assets at end of year2012-12-31$13,186,730
Value of total assets at beginning of year2012-12-31$10,772,650
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$12,538
Total interest from all sources2012-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$332,530
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$332,530
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$500,173
Participant contributions at end of year2012-12-31$4,004
Participant contributions at beginning of year2012-12-31$49,193
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$1,614,632
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$622,225
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$2,107
Liabilities. Value of operating payables at end of year2012-12-31$6,200
Total non interest bearing cash at end of year2012-12-31$121,744
Total non interest bearing cash at beginning of year2012-12-31$203,506
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$2,409,987
Value of net assets at end of year (total assets less liabilities)2012-12-31$13,180,530
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$10,770,543
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Investment advisory and management fees2012-12-31$12,538
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$11,151,244
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$9,447,132
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$499,004
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$1,053,938
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$1,646,888
Employer contributions (assets) at end of year2012-12-31$295,106
Employer contributions (assets) at beginning of year2012-12-31$450,594
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$612,000
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2012-12-31951777440
2011 : RETIREE GROUP MEDICAL BENEFITS PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$2,107
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$2,248
Total income from all sources (including contributions)2011-12-31$2,149,650
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$1,186,011
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$1,171,914
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$2,162,323
Value of total assets at end of year2011-12-31$10,772,650
Value of total assets at beginning of year2011-12-31$9,809,152
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$14,097
Total interest from all sources2011-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$253,359
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$253,359
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$527,149
Participant contributions at end of year2011-12-31$49,193
Participant contributions at beginning of year2011-12-31$48,874
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$622,225
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$2,107
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$2,248
Total non interest bearing cash at end of year2011-12-31$203,506
Total non interest bearing cash at beginning of year2011-12-31$143,232
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$963,639
Value of net assets at end of year (total assets less liabilities)2011-12-31$10,770,543
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$9,806,904
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Investment advisory and management fees2011-12-31$14,097
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$9,447,132
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$9,222,186
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$545,294
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-266,032
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$1,635,174
Employer contributions (assets) at end of year2011-12-31$450,594
Employer contributions (assets) at beginning of year2011-12-31$394,860
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$626,620
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2011-12-31951777440
2010 : RETIREE GROUP MEDICAL BENEFITS PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$684,647
Total unrealized appreciation/depreciation of assets2010-12-31$684,647
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$2,248
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$2,790,488
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$1,094,820
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,082,362
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$1,886,980
Value of total assets at end of year2010-12-31$9,809,152
Value of total assets at beginning of year2010-12-31$8,111,236
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$12,458
Total interest from all sources2010-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$218,861
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$218,861
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$520,221
Participant contributions at end of year2010-12-31$48,874
Participant contributions at beginning of year2010-12-31$47,568
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$2,248
Administrative expenses (other) incurred2010-12-31$12,458
Total non interest bearing cash at end of year2010-12-31$143,232
Total non interest bearing cash at beginning of year2010-12-31$85,440
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$1,695,668
Value of net assets at end of year (total assets less liabilities)2010-12-31$9,806,904
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$8,111,236
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$9,222,186
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$7,654,262
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$472,552
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$1,366,759
Employer contributions (assets) at end of year2010-12-31$394,860
Employer contributions (assets) at beginning of year2010-12-31$323,966
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$609,810
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31GREEN HASSON & JANKS LLP
Accountancy firm EIN2010-12-31951777440

Form 5500 Responses for RETIREE GROUP MEDICAL BENEFITS PLAN

2022: RETIREE GROUP MEDICAL BENEFITS PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: RETIREE GROUP MEDICAL BENEFITS PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedYes
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: RETIREE GROUP MEDICAL BENEFITS PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: RETIREE GROUP MEDICAL BENEFITS PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: RETIREE GROUP MEDICAL BENEFITS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: RETIREE GROUP MEDICAL BENEFITS PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: RETIREE GROUP MEDICAL BENEFITS PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: RETIREE GROUP MEDICAL BENEFITS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: RETIREE GROUP MEDICAL BENEFITS PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedYes
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: RETIREE GROUP MEDICAL BENEFITS PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: RETIREE GROUP MEDICAL BENEFITS PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: RETIREE GROUP MEDICAL BENEFITS PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: RETIREE GROUP MEDICAL BENEFITS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes
2008: RETIREE GROUP MEDICAL BENEFITS PLAN 2008 form 5500 responses
2008-10-01Type of plan entitySingle employer plan
2008-10-01Submission has been amendedYes
2008-10-01This submission is the final filingNo
2008-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2008-10-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number0072727-0
Policy instance 3
Insurance contract or identification number0072727-0
Number of Individuals Covered4
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $286
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,769
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees286
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-001
Policy instance 2
Insurance contract or identification number101555-001
Number of Individuals Covered7
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $708
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $52,098
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $708
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087
Policy instance 1
Insurance contract or identification number8087
Number of Individuals Covered2
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $246
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $246
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087
Policy instance 1
Insurance contract or identification number8087
Number of Individuals Covered4
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $328
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $23,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $328
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-003
Policy instance 2
Insurance contract or identification number101555-003
Number of Individuals Covered11
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,170
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $85,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,170
Insurance broker organization code?4
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC21787
Policy instance 3
Insurance contract or identification numberC21787
Number of Individuals Covered6
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC21787
Policy instance 3
Insurance contract or identification numberC21787
Number of Individuals Covered9
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087
Policy instance 1
Insurance contract or identification number8087
Number of Individuals Covered2
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $390
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $390
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-003
Policy instance 2
Insurance contract or identification number101555-003
Number of Individuals Covered20
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,803
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $110,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,803
Insurance broker organization code?4
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC21787
Policy instance 3
Insurance contract or identification numberC21787
Number of Individuals Covered5
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-001
Policy instance 2
Insurance contract or identification number101555-001
Number of Individuals Covered20
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,586
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $115,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,586
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087
Policy instance 1
Insurance contract or identification number8087
Number of Individuals Covered3
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $588
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $15,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $588
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-001
Policy instance 2
Insurance contract or identification number101555-001
Number of Individuals Covered22
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,089
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $118,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,089
Insurance broker organization code?4
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087
Policy instance 1
Insurance contract or identification number8087
Number of Individuals Covered5
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $973
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $29,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $973
Insurance broker organization code?4
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC21787
Policy instance 3
Insurance contract or identification numberC21787
Number of Individuals Covered11
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-001
Policy instance 2
Insurance contract or identification number101555-001
Number of Individuals Covered12
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,550
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $59,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,550
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67575-0
Policy instance 3
Insurance contract or identification number67575-0
Number of Individuals Covered10
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $217
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees217
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087
Policy instance 1
Insurance contract or identification number8087
Number of Individuals Covered2
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $388
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $10,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $388
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087
Policy instance 1
Insurance contract or identification number8087
Number of Individuals Covered22
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $3,097
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $88,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,097
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-001
Policy instance 2
Insurance contract or identification number101555-001
Number of Individuals Covered112
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10,294
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $452,489
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,294
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC21787
Policy instance 3
Insurance contract or identification numberC21787
Number of Individuals Covered102
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67575-0
Policy instance 4
Insurance contract or identification number67575-0
Number of Individuals Covered102
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,194
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $23,872
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1194
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC21787
Policy instance 3
Insurance contract or identification numberC21787
Number of Individuals Covered106
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-001
Policy instance 2
Insurance contract or identification number101555-001
Number of Individuals Covered119
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,566
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $310,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,566
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087
Policy instance 1
Insurance contract or identification number8087
Number of Individuals Covered23
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,743
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $96,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,743
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67575-0
Policy instance 4
Insurance contract or identification number67575-0
Number of Individuals Covered106
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,341
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $46,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2341
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC21787
Policy instance 3
Insurance contract or identification numberC21787
Number of Individuals Covered89
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087
Policy instance 1
Insurance contract or identification number8087
Number of Individuals Covered18
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,335
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $67,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,335
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-001
Policy instance 2
Insurance contract or identification number101555-001
Number of Individuals Covered119
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,532
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $302,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,532
Amount paid for insurance broker fees0
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67575-0
Policy instance 4
Insurance contract or identification number67575-0
Number of Individuals Covered89
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,704
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $87,794
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1704
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON DELAWARE INC.
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC24661
Policy instance 1
Insurance contract or identification numberC24661
Number of Individuals Covered4
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,803
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-001
Policy instance 3
Insurance contract or identification number101555-001
Number of Individuals Covered114
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,691
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $288,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,691
Insurance broker organization code?4
Insurance broker nameTOWERS WATSON DELAWARE INC.
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087
Policy instance 2
Insurance contract or identification number8087
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087-12,13
Policy instance 3
Insurance contract or identification number8087-12,13
Number of Individuals Covered3
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $428
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $29,353
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC24661
Policy instance 1
Insurance contract or identification numberC24661
Number of Individuals Covered4
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $17,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-0001
Policy instance 2
Insurance contract or identification number101555-0001
Number of Individuals Covered100
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,761
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $231,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number8087-9,12,13
Policy instance 3
Insurance contract or identification number8087-9,12,13
Number of Individuals Covered27
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $230
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $91,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number101555-0001
Policy instance 2
Insurance contract or identification number101555-0001
Number of Individuals Covered100
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,316
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $238,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC24661
Policy instance 1
Insurance contract or identification numberC24661
Number of Individuals Covered0
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,049
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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