401k Plan data: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN plan

BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 401k Plan overview

Plan Name	BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN
Plan identification number	002

BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations. Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.

401k Sponsoring company profile

BLOOD BANK OF HAWAII has sponsored the creation of one or more 401k plans.

Company Name: BLOOD BANK OF HAWAII

Employer identification number (EIN): 990073479

NAIC Classification: 621900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2012-02-01 FILED WITH AUTHORIZED SIGNATURE
002 2011-02-01 ALBERT N. YOZA
002 2010-02-01 ALBERT N. YOZA
002 2009-02-01 ALBERT N. YOZA

Plan id#	Filing Submission Date	Name of Administrator
002	2012-02-01	FILED WITH AUTHORIZED SIGNATURE
002	2011-02-01	ALBERT N. YOZA
002	2010-02-01	ALBERT N. YOZA
002	2009-02-01	ALBERT N. YOZA

Plan Statistics for BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN

401k plan membership statisitcs for BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN

Measure Date Value
2012: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-02-01 228
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 0
Number of retired or separated participants receiving benefits 2012-02-01 0
Number of other retired or separated participants entitled to future benefits 2012-02-01 0
Total of all active and inactive participants 2012-02-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-02-01 0
Total participants 2012-02-01 0
Number of participants with account balances 2012-02-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-02-01 0
2011: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year 2011-02-01 152
Total number of active participants reported on line 7a of the Form 5500 2011-02-01 131
Number of retired or separated participants receiving benefits 2011-02-01 0
Number of other retired or separated participants entitled to future benefits 2011-02-01 96
Total of all active and inactive participants 2011-02-01 227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-02-01 1
Total participants 2011-02-01 228
Number of participants with account balances 2011-02-01 155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-02-01 0
2010: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2010 401k membership
Total participants, beginning-of-year 2010-02-01 157
Total number of active participants reported on line 7a of the Form 5500 2010-02-01 89
Number of retired or separated participants receiving benefits 2010-02-01 0
Number of other retired or separated participants entitled to future benefits 2010-02-01 63
Total of all active and inactive participants 2010-02-01 152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-02-01 0
Total participants 2010-02-01 152
Number of participants with account balances 2010-02-01 121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-02-01 0
2009: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year 2009-02-01 169
Total number of active participants reported on line 7a of the Form 5500 2009-02-01 97
Number of retired or separated participants receiving benefits 2009-02-01 0
Number of other retired or separated participants entitled to future benefits 2009-02-01 103
Total of all active and inactive participants 2009-02-01 200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-02-01 0
Total participants 2009-02-01 200
Number of participants with account balances 2009-02-01 157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-02-01 0

Measure	Date	Value
2012: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-02-01	228
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	0
Number of retired or separated participants receiving benefits	2012-02-01	0
Number of other retired or separated participants entitled to future benefits	2012-02-01	0
Total of all active and inactive participants	2012-02-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-02-01	0
Total participants	2012-02-01	0
Number of participants with account balances	2012-02-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-02-01	0
2011: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2011 401k membership
Total participants, beginning-of-year	2011-02-01	152
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	131
Number of retired or separated participants receiving benefits	2011-02-01	0
Number of other retired or separated participants entitled to future benefits	2011-02-01	96
Total of all active and inactive participants	2011-02-01	227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-02-01	1
Total participants	2011-02-01	228
Number of participants with account balances	2011-02-01	155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-02-01	0
2010: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2010 401k membership
Total participants, beginning-of-year	2010-02-01	157
Total number of active participants reported on line 7a of the Form 5500	2010-02-01	89
Number of retired or separated participants receiving benefits	2010-02-01	0
Number of other retired or separated participants entitled to future benefits	2010-02-01	63
Total of all active and inactive participants	2010-02-01	152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-02-01	0
Total participants	2010-02-01	152
Number of participants with account balances	2010-02-01	121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-02-01	0
2009: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2009 401k membership
Total participants, beginning-of-year	2009-02-01	169
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	97
Number of retired or separated participants receiving benefits	2009-02-01	0
Number of other retired or separated participants entitled to future benefits	2009-02-01	103
Total of all active and inactive participants	2009-02-01	200
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-02-01	0
Total participants	2009-02-01	200
Number of participants with account balances	2009-02-01	157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-02-01	0

Financial Data on BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN

Measure	Date	Value
2013 : BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-01-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-01-31	$455
Total income from all sources (including contributions)	2013-01-31	$664,891
Total loss/gain on sale of assets	2013-01-31	$0
Total of all expenses incurred	2013-01-31	$4,110,653
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-01-31	$4,051,148
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-01-31	$255,901
Value of total assets at end of year	2013-01-31	$0
Value of total assets at beginning of year	2013-01-31	$3,446,217
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-01-31	$59,505
Total interest from all sources	2013-01-31	$1,517
Total dividends received (eg from common stock, registered investment company shares)	2013-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-01-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2013-01-31	$0
Was this plan covered by a fidelity bond	2013-01-31	Yes
Value of fidelity bond cover	2013-01-31	$500,000
If this is an individual account plan, was there a blackout period	2013-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-01-31	No
Contributions received from participants	2013-01-31	$204,790
Participant contributions at end of year	2013-01-31	$0
Participant contributions at beginning of year	2013-01-31	$28,475
Participant contributions at end of year	2013-01-31	$0
Participant contributions at beginning of year	2013-01-31	$8,611
Income. Received or receivable in cash from other sources (including rollovers)	2013-01-31	$3,704
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-01-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-01-31	$455
Administrative expenses (other) incurred	2013-01-31	$59,505
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-01-31	No
Value of net income/loss	2013-01-31	$-3,445,762
Value of net assets at end of year (total assets less liabilities)	2013-01-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2013-01-31	$3,445,762
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-01-31	No
Were any leases to which the plan was party in default or uncollectible	2013-01-31	No
Value of interest in pooled separate accounts at end of year	2013-01-31	$0
Value of interest in pooled separate accounts at beginning of year	2013-01-31	$2,344,865
Interest on participant loans	2013-01-31	$1,517
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-01-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-01-31	$1,009,808
Net investment gain/loss from pooled separate accounts	2013-01-31	$407,473
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-01-31	No
Was there a failure to transmit to the plan any participant contributions	2013-01-31	No
Has the plan failed to provide any benefit when due under the plan	2013-01-31	No
Contributions received in cash from employer	2013-01-31	$47,407
Employer contributions (assets) at end of year	2013-01-31	$0
Employer contributions (assets) at beginning of year	2013-01-31	$54,458
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-01-31	$4,051,148
Did the plan have assets held for investment	2013-01-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-01-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-01-31	Disclaimer
Accountancy firm name	2013-01-31	N&K CPAS, INC.
Accountancy firm EIN	2013-01-31	990169131
2012 : BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-01-31	$455
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-01-31	$2,877
Total income from all sources (including contributions)	2012-01-31	$290,983
Total loss/gain on sale of assets	2012-01-31	$0
Total of all expenses incurred	2012-01-31	$114,465
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-01-31	$113,274
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-01-31	$272,557
Value of total assets at end of year	2012-01-31	$3,446,217
Value of total assets at beginning of year	2012-01-31	$3,272,121
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-01-31	$1,191
Total interest from all sources	2012-01-31	$726
Total dividends received (eg from common stock, registered investment company shares)	2012-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-01-31	No
Was this plan covered by a fidelity bond	2012-01-31	Yes
Value of fidelity bond cover	2012-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2012-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-01-31	No
Contributions received from participants	2012-01-31	$218,035
Participant contributions at end of year	2012-01-31	$28,475
Participant contributions at beginning of year	2012-01-31	$22,063
Participant contributions at end of year	2012-01-31	$8,611
Participant contributions at beginning of year	2012-01-31	$22,304
Income. Received or receivable in cash from other sources (including rollovers)	2012-01-31	$518
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-01-31	$455
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-01-31	$2,877
Administrative expenses (other) incurred	2012-01-31	$1,191
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-01-31	No
Value of net income/loss	2012-01-31	$176,518
Value of net assets at end of year (total assets less liabilities)	2012-01-31	$3,445,762
Value of net assets at beginning of year (total assets less liabilities)	2012-01-31	$3,269,244
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-01-31	No
Were any leases to which the plan was party in default or uncollectible	2012-01-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-01-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-01-31	$0
Value of interest in pooled separate accounts at end of year	2012-01-31	$2,344,865
Value of interest in pooled separate accounts at beginning of year	2012-01-31	$2,161,900
Interest on participant loans	2012-01-31	$726
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-01-31	$1,009,808
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-01-31	$1,013,172
Net investment gain/loss from pooled separate accounts	2012-01-31	$17,700
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-01-31	No
Was there a failure to transmit to the plan any participant contributions	2012-01-31	Yes
Has the plan failed to provide any benefit when due under the plan	2012-01-31	No
Contributions received in cash from employer	2012-01-31	$54,004
Employer contributions (assets) at end of year	2012-01-31	$54,458
Employer contributions (assets) at beginning of year	2012-01-31	$52,682
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-01-31	$113,274
Did the plan have assets held for investment	2012-01-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-01-31	Disclaimer
Accountancy firm name	2012-01-31	N&K CPAS, INC.
Accountancy firm EIN	2012-01-31	990169131
2011 : BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-01-31	$2,877
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-01-31	$0
Total income from all sources (including contributions)	2011-01-31	$660,769
Total loss/gain on sale of assets	2011-01-31	$0
Total of all expenses incurred	2011-01-31	$355,604
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-01-31	$348,049
Expenses. Certain deemed distributions of participant loans	2011-01-31	$6,410
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-01-31	$260,358
Value of total assets at end of year	2011-01-31	$3,272,121
Value of total assets at beginning of year	2011-01-31	$2,964,079
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-01-31	$1,145
Total interest from all sources	2011-01-31	$4,716
Total dividends received (eg from common stock, registered investment company shares)	2011-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-01-31	No
Was this plan covered by a fidelity bond	2011-01-31	Yes
Value of fidelity bond cover	2011-01-31	$1,000,000
If this is an individual account plan, was there a blackout period	2011-01-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-01-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-01-31	No
Contributions received from participants	2011-01-31	$203,435
Participant contributions at end of year	2011-01-31	$22,063
Participant contributions at beginning of year	2011-01-31	$56,266
Participant contributions at end of year	2011-01-31	$22,304
Participant contributions at beginning of year	2011-01-31	$16,388
Income. Received or receivable in cash from other sources (including rollovers)	2011-01-31	$4,241
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-01-31	$2,877
Administrative expenses (other) incurred	2011-01-31	$1,145
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-01-31	No
Value of net income/loss	2011-01-31	$305,165
Value of net assets at end of year (total assets less liabilities)	2011-01-31	$3,269,244
Value of net assets at beginning of year (total assets less liabilities)	2011-01-31	$2,964,079
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-01-31	No
Were any leases to which the plan was party in default or uncollectible	2011-01-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-01-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-01-31	$1,849,917
Value of interest in pooled separate accounts at end of year	2011-01-31	$2,161,900
Interest on participant loans	2011-01-31	$1,514
Interest earned on other investments	2011-01-31	$3,202
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-01-31	$1,013,172
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-01-31	$1,016,298
Net investment gain/loss from pooled separate accounts	2011-01-31	$395,695
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-01-31	No
Was there a failure to transmit to the plan any participant contributions	2011-01-31	No
Has the plan failed to provide any benefit when due under the plan	2011-01-31	No
Contributions received in cash from employer	2011-01-31	$52,682
Employer contributions (assets) at end of year	2011-01-31	$52,682
Employer contributions (assets) at beginning of year	2011-01-31	$25,210
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-01-31	$348,049
Did the plan have assets held for investment	2011-01-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-01-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-01-31	Disclaimer
Accountancy firm name	2011-01-31	KPMG, LLP
Accountancy firm EIN	2011-01-31	135565207
2010 : BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-01-31	$0

Form 5500 Responses for BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN

2012: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2012 form 5500 responses
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	Submission has been amended	No
2012-02-01	This submission is the final filing	Yes
2012-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-02-01	Plan is a collectively bargained plan	No
2012-02-01	Plan funding arrangement – Insurance	Yes
2012-02-01	Plan funding arrangement – Trust	Yes
2012-02-01	Plan benefit arrangement – Insurance	Yes
2012-02-01	Plan benefit arrangement - Trust	Yes
2011: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	Submission has been amended	No
2011-02-01	This submission is the final filing	No
2011-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-02-01	Plan is a collectively bargained plan	No
2011-02-01	Plan funding arrangement – Insurance	Yes
2011-02-01	Plan funding arrangement – Trust	Yes
2011-02-01	Plan benefit arrangement – Insurance	Yes
2011-02-01	Plan benefit arrangement - Trust	Yes
2010: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2010 form 5500 responses
2010-02-01	Type of plan entity	Single employer plan
2010-02-01	Submission has been amended	No
2010-02-01	This submission is the final filing	No
2010-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-02-01	Plan is a collectively bargained plan	No
2010-02-01	Plan funding arrangement – Insurance	Yes
2010-02-01	Plan funding arrangement – Trust	Yes
2010-02-01	Plan benefit arrangement – Insurance	Yes
2010-02-01	Plan benefit arrangement - Trust	Yes
2009: BLOOD BANK OF HAWAII TAX DEFERRED ANNUITY PLAN 2009 form 5500 responses
2009-02-01	Type of plan entity	Single employer plan
2009-02-01	Submission has been amended	No
2009-02-01	This submission is the final filing	No
2009-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-02-01	Plan is a collectively bargained plan	No
2009-02-01	Plan funding arrangement – Insurance	Yes
2009-02-01	Plan funding arrangement – Trust	Yes
2009-02-01	Plan benefit arrangement – Insurance	Yes
2009-02-01	Plan benefit arrangement - Trust	Yes

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Company Name:	BLOOD BANK OF HAWAII
Employer identification number (EIN):	990073479
NAIC Classification:	621900