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FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameFIRST COMMUNITY BANK HEALTH AND WELFARE PLAN
Plan identification number 501

FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    FIRST COMMUNITY BANK has sponsored the creation of one or more 401k plans.

    Company Name:FIRST COMMUNITY BANK
    Employer identification number (EIN):201904513
    NAIC Classification:522110
    NAIC Description:Commercial Banking

    Additional information about FIRST COMMUNITY BANK

    Jurisdiction of Incorporation: California Department of State
    Incorporation Date:
    Company Identification Number: C2679526

    More information about FIRST COMMUNITY BANK

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012021-01-01JESSICA SOULIE2022-09-19
    5012020-01-01JESSICA SOULIE2021-10-07
    5012019-01-01JESSICA SOULIE2020-09-30
    5012018-01-01NICOLE SAGE2019-07-26
    5012018-01-01JESSICA SOULIE2020-09-30
    5012017-01-01
    5012016-01-01NICOLE SAGE-NELLOR
    5012015-01-01NICOLE SAGE-NELLOR

    Plan Statistics for FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN

    401k plan membership statisitcs for FIRST COMMUNITY BANK HEALTH AND WELFARE PLAN

    Measure Date Value
    2021
    Total participants, beginning-of-year2021-01-01175
    Total number of active participants reported on line 7a of the Form 55002021-01-01142
    Number of retired or separated participants receiving benefits2021-01-011
    Number of other retired or separated participants entitled to future benefits2021-01-010
    Total of all active and inactive participants2021-01-01143
    Number of employers contributing to the scheme2021-01-010
    2020
    Total participants, beginning-of-year2020-01-01173
    Total number of active participants reported on line 7a of the Form 55002020-01-01150
    Number of retired or separated participants receiving benefits2020-01-013
    Number of other retired or separated participants entitled to future benefits2020-01-015
    Total of all active and inactive participants2020-01-01158
    2019
    Total participants, beginning-of-year2019-01-01145
    Total number of active participants reported on line 7a of the Form 55002019-01-01164
    Number of retired or separated participants receiving benefits2019-01-012
    Number of other retired or separated participants entitled to future benefits2019-01-017
    Total of all active and inactive participants2019-01-01173
    2018
    Total participants, beginning-of-year2018-01-01114
    Total number of active participants reported on line 7a of the Form 55002018-01-01145
    Number of retired or separated participants receiving benefits2018-01-010
    Number of other retired or separated participants entitled to future benefits2018-01-010
    Total of all active and inactive participants2018-01-01145
    2017
    Total participants, beginning-of-year2017-01-01113
    Total number of active participants reported on line 7a of the Form 55002017-01-01112
    Number of retired or separated participants receiving benefits2017-01-012
    Number of other retired or separated participants entitled to future benefits2017-01-010
    Total of all active and inactive participants2017-01-01114
    2016
    Total participants, beginning-of-year2016-01-01112
    Total number of active participants reported on line 7a of the Form 55002016-01-01109
    Number of retired or separated participants receiving benefits2016-01-014
    Number of other retired or separated participants entitled to future benefits2016-01-010
    Total of all active and inactive participants2016-01-01113
    2015
    Total participants, beginning-of-year2015-01-01102
    Total number of active participants reported on line 7a of the Form 55002015-01-01110
    Number of retired or separated participants receiving benefits2015-01-012
    Number of other retired or separated participants entitled to future benefits2015-01-010
    Total of all active and inactive participants2015-01-01112

    Form 5500 Responses

    2021
    2021-01-01Type of plan entitySingle employer plan
    2021-01-01Plan funding arrangement – InsuranceYes
    2021-01-01Plan funding arrangement – General assets of the sponsorYes
    2021-01-01Plan benefit arrangement – InsuranceYes
    2021-01-01Plan benefit arrangement – General assets of the sponsorYes
    2020
    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 – General assets of the sponsorYes
    2020-01-01Plan benefit arrangement – InsuranceYes
    2020-01-01Plan benefit arrangement – General assets of the sponsorYes
    2019
    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 – General assets of the sponsorYes
    2019-01-01Plan benefit arrangement – InsuranceYes
    2019-01-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    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 – General assets of the sponsorYes
    2018-01-01Plan benefit arrangement – InsuranceYes
    2018-01-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    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 – General assets of the sponsorYes
    2017-01-01Plan benefit arrangement – InsuranceYes
    2017-01-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    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 – General assets of the sponsorYes
    2016-01-01Plan benefit arrangement – InsuranceYes
    2016-01-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-01-01Type of plan entitySingle employer plan
    2015-01-01First time form 5500 has been submittedYes
    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 – General assets of the sponsorYes
    2015-01-01Plan benefit arrangement – InsuranceYes
    2015-01-01Plan benefit arrangement – General assets of the sponsorYes

    Insurance Providers Used on plan

    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 60053 )
    Policy contract number604014
    Policy instance 4
    Insurance contract or identification number604014
    Number of Individuals Covered103
    Insurance policy start date2020-04-01
    Insurance policy end date2021-03-31
    Total amount of commissions paid to insurance brokerUSD $37,297
    Total amount of fees paid to insurance companyUSD $0
    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
    Welfare Benefit Premiums Paid to CarrierUSD $817,811
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $34,737
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number454170
    Policy instance 3
    Insurance contract or identification number454170
    Number of Individuals Covered150
    Insurance policy start date2020-04-01
    Insurance policy end date2021-03-31
    Total amount of commissions paid to insurance brokerUSD $9,110
    Total amount of fees paid to insurance companyUSD $2,977
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
    Welfare Benefit Premiums Paid to CarrierUSD $104,478
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
    Commission paid to Insurance BrokerUSD $9,084
    Amount paid for insurance broker fees2977
    Additional information about fees paid to insurance brokerFEES
    Insurance broker organization code?3
    CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
    Policy contract numberW0072555
    Policy instance 2
    Insurance contract or identification numberW0072555
    Number of Individuals Covered122
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $45,681
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $864,478
    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 fees35384
    Additional information about fees paid to insurance brokerPRODUCER SERVICE FEES
    Insurance broker organization code?3
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract number5958032
    Policy instance 1
    Insurance contract or identification number5958032
    Number of Individuals Covered273
    Insurance policy start date2020-04-01
    Insurance policy end date2021-03-31
    Total amount of commissions paid to insurance brokerUSD $17,767
    Total amount of fees paid to insurance companyUSD $2,100
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $163,047
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $17,767
    Amount paid for insurance broker fees35
    Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
    Insurance broker organization code?3
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract number5958032
    Policy instance 1
    Insurance contract or identification number5958032
    Number of Individuals Covered280
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $19,247
    Total amount of fees paid to insurance companyUSD $2,200
    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 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
    Welfare Benefit Premiums Paid to CarrierUSD $157,954
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $19,247
    Amount paid for insurance broker fees35
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number0914103
    Policy instance 2
    Insurance contract or identification number0914103
    Number of Individuals Covered72
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $57,933
    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 $1,181,496
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $57,933
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSIONS
    Insurance broker organization code?3
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 60053 )
    Policy contract number604014
    Policy instance 3
    Insurance contract or identification number604014
    Number of Individuals Covered97
    Insurance policy start date2020-04-01
    Insurance policy end date2021-03-31
    Total amount of commissions paid to insurance brokerUSD $34,737
    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 $766,614
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $34,737
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSIONS
    Insurance broker organization code?3
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00454170
    Policy instance 4
    Insurance contract or identification number00454170
    Number of Individuals Covered151
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $9,098
    Total amount of fees paid to insurance companyUSD $5,012
    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 BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D, WORKSITE BENEFITS
    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 $104,715
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,074
    Amount paid for insurance broker fees5012
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 60053 )
    Policy contract number234156
    Policy instance 5
    Insurance contract or identification number234156
    Number of Individuals Covered6
    Insurance policy start date2020-04-01
    Insurance policy end date2021-03-31
    Total amount of commissions paid to insurance brokerUSD $2,560
    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 $51,197
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,560
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSIONS
    Insurance broker organization code?3
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 60053 )
    Policy contract number234156
    Policy instance 6
    Insurance contract or identification number234156
    Number of Individuals Covered8
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $2,842
    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 $53,991
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,842
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSIONS
    Insurance broker organization code?3
    AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
    Policy contract number0805956
    Policy instance 5
    Insurance contract or identification number0805956
    Number of Individuals Covered301
    Insurance policy start date2019-01-01
    Insurance policy end date2019-03-31
    Total amount of commissions paid to insurance brokerUSD $4,718
    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 $39,200
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,718
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSIONS
    Insurance broker organization code?3
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00454170
    Policy instance 4
    Insurance contract or identification number00454170
    Number of Individuals Covered154
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $8,960
    Total amount of fees paid to insurance companyUSD $5,249
    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 BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT, WORKSITE BENEFITS
    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 $103,063
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,945
    Amount paid for insurance broker fees5249
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 60053 )
    Policy contract number604014
    Policy instance 3
    Insurance contract or identification number604014
    Number of Individuals Covered87
    Insurance policy start date2019-04-01
    Insurance policy end date2020-03-31
    Total amount of commissions paid to insurance brokerUSD $31,251
    Total amount of fees paid to insurance companyUSD $348
    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 $579,082
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $31,251
    Amount paid for insurance broker fees348
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number0914103
    Policy instance 2
    Insurance contract or identification number0914103
    Number of Individuals Covered78
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $51,593
    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 $951,058
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $51,593
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSIONS
    Insurance broker organization code?3
    METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
    Policy contract number5958032
    Policy instance 1
    Insurance contract or identification number5958032
    Number of Individuals Covered284
    Insurance policy start date2019-04-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $10,627
    Total amount of fees paid to insurance companyUSD $1,082
    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 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
    Welfare Benefit Premiums Paid to CarrierUSD $121,348
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,627
    Amount paid for insurance broker fees84
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 60053 )
    Policy contract number234156
    Policy instance 6
    Insurance contract or identification number234156
    Number of Individuals Covered1
    Insurance policy start date2018-09-01
    Insurance policy end date2019-03-31
    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 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 $2,842
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
    Policy contract number0805956
    Policy instance 1
    Insurance contract or identification number0805956
    Number of Individuals Covered240
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $13,117
    Total amount of fees paid to insurance companyUSD $687
    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 $119,125
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $13,117
    Amount paid for insurance broker fees687
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    Insurance broker nameALLIANT INSURANCE SERVICES
    BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
    Policy contract number277647
    Policy instance 2
    Insurance contract or identification number277647
    Number of Individuals Covered202
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $35,956
    Total amount of fees paid to insurance companyUSD $238
    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 $741,576
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $35,956
    Amount paid for insurance broker fees238
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    Insurance broker nameALLIANT INSURANCE SERVICES, INC.
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 60053 )
    Policy contract number604014
    Policy instance 3
    Insurance contract or identification number604014
    Number of Individuals Covered76
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $20,591
    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 $433,801
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $20,591
    Amount paid for insurance broker fees0
    Additional information about fees paid to insurance brokerCOMMISSIONS
    Insurance broker organization code?3
    Insurance broker nameALLIANT INSURANCE SERVICES, INC.
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number00454170
    Policy instance 4
    Insurance contract or identification number00454170
    Number of Individuals Covered112
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $8,098
    Total amount of fees paid to insurance companyUSD $4,736
    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 BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT, WORKSITE BENEFITS
    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 $84,465
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,090
    Amount paid for insurance broker fees4736
    Additional information about fees paid to insurance brokerCOMMISSIONS AND FEES
    Insurance broker organization code?3
    Insurance broker nameWILLNER-WHITTEKER INS. SERVICE
    THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
    Policy contract number454170
    Policy instance 4
    Insurance contract or identification number454170
    Number of Individuals Covered113
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $7,079
    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 BenefitYes
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM, CRITICAL ILLNESS, ACCIDENT
    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 $74,422
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,558
    Insurance broker organization code?3
    Insurance broker nameALLIANT INSURANCE SERVICES, INC.
    KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 60053 )
    Policy contract number604014
    Policy instance 3
    Insurance contract or identification number604014
    Number of Individuals Covered49
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $14,657
    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 $292,565
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $12,368
    Insurance broker organization code?3
    Insurance broker nameALLIANT INSURANCE SERVICES, INC.
    ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
    Policy contract number277647
    Policy instance 2
    Insurance contract or identification number277647
    Number of Individuals Covered155
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $26,620
    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 $671,602
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $24,202
    Insurance broker organization code?3
    Insurance broker nameALLIANT INSURANCE SERVICES, INC.
    STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
    Policy contract number751569
    Policy instance 1
    Insurance contract or identification number751569
    Number of Individuals Covered99
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $8,719
    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 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
    Commission paid to Insurance BrokerUSD $8,719
    Insurance broker organization code?3
    Insurance broker nameBANKER BENEFITS

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