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HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameHBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN
Plan identification number 503

HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

HBM ACQUISITIONS LLC has sponsored the creation of one or more 401k plans.

Company Name:HBM ACQUISITIONS LLC
Employer identification number (EIN):204987841
NAIC Classification:561790
NAIC Description:Other Services to Buildings and Dwellings

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032021-07-01
5032020-07-01
5032019-07-01
5032018-07-01
5032017-07-01
5032016-07-01DAWN EYMAN
5032015-07-01DAWN EYMAN
5032014-07-01DAWN TAMASHIRO JANET KWONG2016-04-06
5032013-07-01DAWN TAMASHIRO
5032012-07-01DAWN TAMASHIRO
5032011-07-01DAWN TAMASHIRO
5032010-07-01DAWN TAMASHIRO
5032010-04-01DAWN TAMASHIRO
5032010-04-01DAWN TAMASHIRO
5032009-07-01DAWN TAMASHIRO

Plan Statistics for HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN

Measure Date Value
2021: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01406
Total number of active participants reported on line 7a of the Form 55002021-07-01340
Number of retired or separated participants receiving benefits2021-07-010
Total of all active and inactive participants2021-07-01340
Total participants2021-07-01340
2020: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01397
Total number of active participants reported on line 7a of the Form 55002020-07-01337
Number of retired or separated participants receiving benefits2020-07-012
Total of all active and inactive participants2020-07-01339
Total participants2020-07-01339
2019: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01404
Total number of active participants reported on line 7a of the Form 55002019-07-01330
Number of retired or separated participants receiving benefits2019-07-012
Total of all active and inactive participants2019-07-01332
Total participants2019-07-01332
2018: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01394
Total number of active participants reported on line 7a of the Form 55002018-07-01334
Number of retired or separated participants receiving benefits2018-07-010
Total of all active and inactive participants2018-07-01334
Total participants2018-07-01334
2017: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01373
Total number of active participants reported on line 7a of the Form 55002017-07-01311
Number of retired or separated participants receiving benefits2017-07-014
Total of all active and inactive participants2017-07-01315
Total participants2017-07-01315
2016: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01352
Total number of active participants reported on line 7a of the Form 55002016-07-01301
Number of retired or separated participants receiving benefits2016-07-012
Total of all active and inactive participants2016-07-01303
Total participants2016-07-01303
2015: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01374
Total number of active participants reported on line 7a of the Form 55002015-07-01273
Number of retired or separated participants receiving benefits2015-07-013
Total of all active and inactive participants2015-07-01276
Total participants2015-07-01276
2014: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01358
Total number of active participants reported on line 7a of the Form 55002014-07-01298
Number of retired or separated participants receiving benefits2014-07-011
Total of all active and inactive participants2014-07-01299
Total participants2014-07-01299
2013: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01281
Total number of active participants reported on line 7a of the Form 55002013-07-01276
Total of all active and inactive participants2013-07-01276
Total participants2013-07-01276
2012: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01215
Total number of active participants reported on line 7a of the Form 55002012-07-01281
Total of all active and inactive participants2012-07-01281
Total participants2012-07-01281
2011: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01190
Total number of active participants reported on line 7a of the Form 55002011-07-01212
Number of retired or separated participants receiving benefits2011-07-013
Total of all active and inactive participants2011-07-01215
Total participants2011-07-01215
2010: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-07-01210
Total number of active participants reported on line 7a of the Form 55002010-07-01189
Number of retired or separated participants receiving benefits2010-07-011
Number of other retired or separated participants entitled to future benefits2010-07-010
Total of all active and inactive participants2010-07-01190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-07-010
Total participants2010-07-01190
Total participants, beginning-of-year2010-04-01200
Total number of active participants reported on line 7a of the Form 55002010-04-01168
Number of retired or separated participants receiving benefits2010-04-0142
Number of other retired or separated participants entitled to future benefits2010-04-010
Total of all active and inactive participants2010-04-01210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-04-010
Total participants2010-04-01210
2009: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01200
Total number of active participants reported on line 7a of the Form 55002009-07-01168
Number of retired or separated participants receiving benefits2009-07-0142
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-01210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-07-010
Total participants2009-07-01210

Financial Data on HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN

Measure Date Value
2016 : HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$0
Total income from all sources (including contributions)2016-06-30$0
Total loss/gain on sale of assets2016-06-30$0
Total of all expenses incurred2016-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$0
Value of total assets at end of year2016-06-30$0
Value of total assets at beginning of year2016-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-06-30$0
Total interest from all sources2016-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2016-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-06-30No
Was this plan covered by a fidelity bond2016-06-30No
Were there any nonexempt tranactions with any party-in-interest2016-06-30No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Value of net income/loss2016-06-30$0
Value of net assets at end of year (total assets less liabilities)2016-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-06-30No
Were any leases to which the plan was party in default or uncollectible2016-06-30No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-06-30No
Was there a failure to transmit to the plan any participant contributions2016-06-30No
Has the plan failed to provide any benefit when due under the plan2016-06-30No
Did the plan have assets held for investment2016-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-06-30No

Form 5500 Responses for HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN

2021: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan benefit arrangement – InsuranceYes
2010-04-01Type of plan entitySingle employer plan
2010-04-01First time form 5500 has been submittedYes
2010-04-01Submission has been amendedYes
2010-04-01This submission is the final filingNo
2010-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2010-04-01Plan is a collectively bargained planNo
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan benefit arrangement – InsuranceYes
2009: HBM ACQUISITIONS LLC HMAA EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01First time form 5500 has been submittedYes
2009-07-01Submission has been amendedYes
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number50302H
Policy instance 1
Insurance contract or identification number50302H
Number of Individuals Covered397
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $57,832
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 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 $1,937,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $57,832
Insurance broker organization code?3
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number50302H
Policy instance 1
Insurance contract or identification number50302H
Number of Individuals Covered406
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $56,208
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 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 $1,884,233
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,208
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number50302H
Policy instance 1
Insurance contract or identification number50302H
Number of Individuals Covered397
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $45,796
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 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 $1,832,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,796
Insurance broker organization code?3
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number50302H
Policy instance 1
Insurance contract or identification number50302H
Number of Individuals Covered404
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $46,428
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 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 $1,593,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,428
Insurance broker organization code?3
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number50302H
Policy instance 1
Insurance contract or identification number50302H
Number of Individuals Covered394
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $40,736
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $1,360,889
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number50302H
Policy instance 1
Insurance contract or identification number50302H
Number of Individuals Covered352
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $54,638
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 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 $1,145,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $54,638
Insurance broker organization code?3
Insurance broker nameP.S.H INSURANCE INC.
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number50302H
Policy instance 1
Insurance contract or identification number50302H
Number of Individuals Covered374
Insurance policy start date2014-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $55,351
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 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 $1,124,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55,351
Insurance broker organization code?3
Insurance broker nameP.S.H. INSURANCE, INC.
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number50302H
Policy instance 1
Insurance contract or identification number50302H
Number of Individuals Covered358
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $67,458
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 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 $1,350,965
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $67,458
Insurance broker organization code?3
Insurance broker nameP.S.H. INSURANCE INC.
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number50302H
Policy instance 1
Insurance contract or identification number50302H
Number of Individuals Covered369
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $62,743
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare 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 $1,206,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,743
Insurance broker nameP.S.H. INSURANCE, INC.
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number50302H
Policy instance 1
Insurance contract or identification number50302H
Number of Individuals Covered281
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $50,190
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,003,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HAWAII MEDICAL ASSURANCE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 48330 )
Policy contract number50302H
Policy instance 1
Insurance contract or identification number50302H
Number of Individuals Covered236
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $42,735
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $854,669
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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