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MUFG BANK, LTD. HEALTH BENEFIT PLAN 401k Plan overview

Plan NameMUFG BANK, LTD. HEALTH BENEFIT PLAN
Plan identification number 541

MUFG BANK, LTD. HEALTH BENEFIT PLAN Benefits

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

401k Sponsoring company profile

MUFG BANK, LTD has sponsored the creation of one or more 401k plans.

Company Name:MUFG BANK, LTD
Employer identification number (EIN):135611741
NAIC Classification:522110
NAIC Description:Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MUFG BANK, LTD. HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5412023-01-01JOSEPH TAGYE2024-10-13 JOSEPH TAGYE2024-10-13
5412022-12-01JOSEPH TAGYE2023-10-15 JOSEPH TAGYE2023-10-15

Financial Data on MUFG BANK, LTD. HEALTH BENEFIT PLAN

Measure Date Value
2023 : MUFG BANK, LTD. HEALTH BENEFIT PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets2023-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$14,321,002
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$5,727,465
Total income from all sources (including contributions)2023-12-31$85,343,425
Total loss/gain on sale of assets2023-12-31$0
Total of all expenses incurred2023-12-31$110,779,801
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$107,209,737
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$84,703,315
Value of total assets at end of year2023-12-31$4,040,905
Value of total assets at beginning of year2023-12-31$20,883,744
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$3,570,064
Total interest from all sources2023-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2023-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-12-31No
Was this plan covered by a fidelity bond2023-12-31Yes
Value of fidelity bond cover2023-12-31$100,000,000
If this is an individual account plan, was there a blackout period2023-12-31No
Were there any nonexempt tranactions with any party-in-interest2023-12-31No
Contributions received from participants2023-12-31$26,127,597
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2023-12-31$21,523,854
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-12-31$4,040,905
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-12-31$4,108,002
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-12-31$2,449,048
Other income not declared elsewhere2023-12-31$640,110
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Value of net income/loss2023-12-31$-25,436,376
Value of net assets at end of year (total assets less liabilities)2023-12-31$-10,280,097
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$15,156,279
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-12-31No
Were any leases to which the plan was party in default or uncollectible2023-12-31No
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2023-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2023-12-31$20,883,744
Expenses. Payments to insurance carriers foe the provision of benefits2023-12-31$9,933,206
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-12-31No
Was there a failure to transmit to the plan any participant contributions2023-12-31No
Has the plan failed to provide any benefit when due under the plan2023-12-31No
Contributions received in cash from employer2023-12-31$58,575,718
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-12-31$75,752,677
Contract administrator fees2023-12-31$3,570,064
Liabilities. Value of benefit claims payable at end of year2023-12-31$10,213,000
Liabilities. Value of benefit claims payable at beginning of year2023-12-31$3,278,417
Did the plan have assets held for investment2023-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-12-31No
Opinion of an independent qualified public accountant for this plan2023-12-31Unqualified
Accountancy firm name2023-12-31DELOITTE & TOUCHE LLP
Accountancy firm EIN2023-12-31133891517
Total unrealized appreciation/depreciation of assets2023-01-01$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-01-01$14,321,002
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-01-01$5,727,465
Total income from all sources (including contributions)2023-01-01$85,343,425
Total loss/gain on sale of assets2023-01-01$0
Total of all expenses incurred2023-01-01$110,779,801
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-01-01$107,209,737
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-01-01$84,703,315
Value of total assets at end of year2023-01-01$4,040,905
Value of total assets at beginning of year2023-01-01$20,883,744
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-01-01$3,570,064
Total interest from all sources2023-01-01$0
Total dividends received (eg from common stock, registered investment company shares)2023-01-01$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-01-01No
Was this plan covered by a fidelity bond2023-01-01Yes
Value of fidelity bond cover2023-01-01$100,000,000
If this is an individual account plan, was there a blackout period2023-01-01No
Were there any nonexempt tranactions with any party-in-interest2023-01-01No
Contributions received from participants2023-01-01$26,127,597
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2023-01-01$21,523,854
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-01-01$4,040,905
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-01-01$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-01-01$4,108,002
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-01-01$2,449,048
Other income not declared elsewhere2023-01-01$640,110
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-01-01No
Value of net income/loss2023-01-01$-25,436,376
Value of net assets at end of year (total assets less liabilities)2023-01-01$-10,280,097
Value of net assets at beginning of year (total assets less liabilities)2023-01-01$15,156,279
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-01-01No
Were any loans by the plan or fixed income obligations due to the plan in default2023-01-01No
Were any leases to which the plan was party in default or uncollectible2023-01-01No
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2023-01-01$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2023-01-01$20,883,744
Expenses. Payments to insurance carriers foe the provision of benefits2023-01-01$9,933,206
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-01-01No
Was there a failure to transmit to the plan any participant contributions2023-01-01No
Has the plan failed to provide any benefit when due under the plan2023-01-01No
Contributions received in cash from employer2023-01-01$58,575,718
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-01-01$75,752,677
Contract administrator fees2023-01-01$3,570,064
Liabilities. Value of benefit claims payable at end of year2023-01-01$10,213,000
Liabilities. Value of benefit claims payable at beginning of year2023-01-01$3,278,417
Did the plan have assets held for investment2023-01-01No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-01-01No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-01-01No
Opinion of an independent qualified public accountant for this plan2023-01-011
Accountancy firm name2023-01-01DELOITTE & TOUCHE LLP
Accountancy firm EIN2023-01-01133891517
2022 : MUFG BANK, LTD. HEALTH BENEFIT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total transfer of assets to this plan2022-12-31$23,040,439
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$5,727,465
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-189,306
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$7,694,854
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$7,408,309
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,967,389
Value of total assets at end of year2022-12-31$20,883,744
Value of total assets at beginning of year2022-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$286,545
Total interest from all sources2022-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$100,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$1,967,389
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$852,702
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$2,449,048
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$-2,156,695
Administrative expenses (other) incurred2022-12-31$286,545
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-7,884,160
Value of net assets at end of year (total assets less liabilities)2022-12-31$15,156,279
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$0
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
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$20,883,744
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$742,568
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$5,813,039
Liabilities. Value of benefit claims payable at end of year2022-12-31$3,278,417
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$0
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 name2022-12-31DELOITTE & TOUCHE LLP
Accountancy firm EIN2022-12-31133891517
Total unrealized appreciation/depreciation of assets2022-12-01$0
Total transfer of assets to this plan2022-12-01$23,040,439
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-01$5,727,465
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-01$0
Total income from all sources (including contributions)2022-12-01$-189,306
Total loss/gain on sale of assets2022-12-01$0
Total of all expenses incurred2022-12-01$7,694,854
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-01$7,408,309
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-01$1,967,389
Value of total assets at end of year2022-12-01$20,883,744
Value of total assets at beginning of year2022-12-01$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-01$286,545
Total interest from all sources2022-12-01$0
Total dividends received (eg from common stock, registered investment company shares)2022-12-01$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-01No
Was this plan covered by a fidelity bond2022-12-01Yes
Value of fidelity bond cover2022-12-01$100,000,000
If this is an individual account plan, was there a blackout period2022-12-01No
Were there any nonexempt tranactions with any party-in-interest2022-12-01No
Contributions received from participants2022-12-01$1,967,389
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-01$852,702
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-01$2,449,048
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-01$0
Other income not declared elsewhere2022-12-01$-2,156,695
Administrative expenses (other) incurred2022-12-01$286,545
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-01No
Value of net income/loss2022-12-01$-7,884,160
Value of net assets at end of year (total assets less liabilities)2022-12-01$15,156,279
Value of net assets at beginning of year (total assets less liabilities)2022-12-01$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-01No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-01No
Were any leases to which the plan was party in default or uncollectible2022-12-01No
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-01$20,883,744
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-01$0
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-01$742,568
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-01No
Was there a failure to transmit to the plan any participant contributions2022-12-01No
Has the plan failed to provide any benefit when due under the plan2022-12-01No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-01$5,813,039
Liabilities. Value of benefit claims payable at end of year2022-12-01$3,278,417
Liabilities. Value of benefit claims payable at beginning of year2022-12-01$0
Did the plan have assets held for investment2022-12-01Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-01No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-01No
Opinion of an independent qualified public accountant for this plan2022-12-011
Accountancy firm name2022-12-01DELOITTE & TOUCHE LLP
Accountancy firm EIN2022-12-01133891517

Form 5500 Responses for MUFG BANK, LTD. HEALTH BENEFIT PLAN

2023: MUFG BANK, LTD. HEALTH BENEFIT PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: MUFG BANK, LTD. HEALTH BENEFIT PLAN 2022 form 5500 responses
2022-12-01Type of plan entitySingle employer plan
2022-12-01First time form 5500 has been submittedYes
2022-12-01Submission has been amendedNo
2022-12-01This submission is the final filingNo
2022-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-12-01Plan is a collectively bargained planNo
2022-12-01Plan funding arrangement – InsuranceYes
2022-12-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )
Policy contract number40148266
Policy instance 7
Insurance contract or identification number40148266
Number of Individuals Covered4637
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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?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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberVG019
Policy instance 6
Insurance contract or identification numberVG019
Number of Individuals Covered0
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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?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
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: 00000 )
Policy contract number235705
Policy instance 5
Insurance contract or identification number235705
Number of Individuals Covered758
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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?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 $6,489,202
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: 00000 )
Policy contract number607349
Policy instance 4
Insurance contract or identification number607349
Number of Individuals Covered255
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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?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 $1,658,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number4EL-7924-23
Policy instance 3
Insurance contract or identification number4EL-7924-23
Number of Individuals Covered10
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $5,221
Total amount of fees paid to insurance companyUSD $603
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 $65,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )
Policy contract number21773
Policy instance 2
Insurance contract or identification number21773
Number of Individuals Covered4143
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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?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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )
Policy contract number79572
Policy instance 1
Insurance contract or identification number79572
Number of Individuals Covered1640
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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?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 BenefitYes
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 $326,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )
Policy contract number40148266
Policy instance 7
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberVG019
Policy instance 6
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number235705
Policy instance 5
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number607349
Policy instance 4
FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 )
Policy contract number4EL-7924-22
Policy instance 3
DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )
Policy contract number21773
Policy instance 2
DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )
Policy contract number79572
Policy instance 1

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