401k Plan data: HAWAII MEDICAL SERVICE ASSOCIATION plan

HAWAII MEDICAL SERVICE ASSOCIATION 401k Plan overview

Plan Name	HAWAII MEDICAL SERVICE ASSOCIATION
Plan identification number	505

HAWAII MEDICAL SERVICE ASSOCIATION Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

ATLANTIS CRUISES LLC has sponsored the creation of one or more 401k plans.

Company Name: ATLANTIS CRUISES LLC

Employer identification number (EIN): 061714421

NAIC Classification: 713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HAWAII MEDICAL SERVICE ASSOCIATION

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2015-01-01 GEORGE ANN SKANDIS GEORGE ANN SKANDIS 2016-07-20
505 2014-01-01 GEORGE ANN SKANDIS GEORGE ANN SKANDIS 2015-07-13
505 2013-01-01 GEORGE ANN SKANDIS GEORGE ANN SKANDIS 2014-07-15
505 2012-01-01 GEORGE ANN SKANDIS GEORGE ANN SKANDIS 2013-07-12
505 2011-01-01 GEORGE ANN SKANDIS 2012-07-13
505 2010-01-01 GEORGE ANN SKANDIS 2011-06-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2015-01-01	GEORGE ANN SKANDIS		GEORGE ANN SKANDIS	2016-07-20
505	2014-01-01	GEORGE ANN SKANDIS		GEORGE ANN SKANDIS	2015-07-13
505	2013-01-01	GEORGE ANN SKANDIS		GEORGE ANN SKANDIS	2014-07-15
505	2012-01-01	GEORGE ANN SKANDIS		GEORGE ANN SKANDIS	2013-07-12
505	2011-01-01	GEORGE ANN SKANDIS	2012-07-13
505	2010-01-01	GEORGE ANN SKANDIS	2011-06-28

Plan Statistics for HAWAII MEDICAL SERVICE ASSOCIATION

401k plan membership statisitcs for HAWAII MEDICAL SERVICE ASSOCIATION

Measure Date Value
2015: HAWAII MEDICAL SERVICE ASSOCIATION 2015 401k membership
Total participants, beginning-of-year 2015-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 35
Total of all active and inactive participants 2015-01-01 35
Total participants 2015-01-01 35
2014: HAWAII MEDICAL SERVICE ASSOCIATION 2014 401k membership
Total participants, beginning-of-year 2014-01-01 29
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 27
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 28
Total participants 2014-01-01 28
2013: HAWAII MEDICAL SERVICE ASSOCIATION 2013 401k membership
Total participants, beginning-of-year 2013-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 29
Number of retired or separated participants receiving benefits 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 31
Number of participants with account balances 2013-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
Number of employers contributing to the scheme 2013-01-01 0
2012: HAWAII MEDICAL SERVICE ASSOCIATION 2012 401k membership
Total participants, beginning-of-year 2012-01-01 24
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 27
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
Number of employers contributing to the scheme 2012-01-01 0

Measure	Date	Value
2015: HAWAII MEDICAL SERVICE ASSOCIATION 2015 401k membership
Total participants, beginning-of-year	2015-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	35
Total of all active and inactive participants	2015-01-01	35
Total participants	2015-01-01	35
2014: HAWAII MEDICAL SERVICE ASSOCIATION 2014 401k membership
Total participants, beginning-of-year	2014-01-01	29
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	27
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	28
Total participants	2014-01-01	28
2013: HAWAII MEDICAL SERVICE ASSOCIATION 2013 401k membership
Total participants, beginning-of-year	2013-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	29
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	31
Number of participants with account balances	2013-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
Number of employers contributing to the scheme	2013-01-01	0
2012: HAWAII MEDICAL SERVICE ASSOCIATION 2012 401k membership
Total participants, beginning-of-year	2012-01-01	24
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	27
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
Number of employers contributing to the scheme	2012-01-01	0

Form 5500 Responses for HAWAII MEDICAL SERVICE ASSOCIATION

2015: HAWAII MEDICAL SERVICE ASSOCIATION 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: HAWAII MEDICAL SERVICE ASSOCIATION 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: HAWAII MEDICAL SERVICE ASSOCIATION 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: HAWAII MEDICAL SERVICE ASSOCIATION 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	First time form 5500 has been submitted	Yes
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

88460

Policy instance

Insurance contract or identification number	88460
Number of Individuals Covered	35
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $185,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

88460

Policy instance

Insurance contract or identification number	88460
Number of Individuals Covered	27
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $145,981

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

88460

Policy instance

Insurance contract or identification number	88460
Number of Individuals Covered	29
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $171,599
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOC. (National Association of Insurance Commissioners NAIC id number: 49948 )

Policy contract number

88460

Policy instance

Insurance contract or identification number	88460
Number of Individuals Covered	27
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $165,721
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Insurance broker name

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Company Name:	ATLANTIS CRUISES LLC
Employer identification number (EIN):	061714421
NAIC Classification:	713900